Covid-19Do I Need a Booster? What to Know About a Fourth Dose

Do I Need a Booster? What to Know About a Fourth Dose

The Biden administration has just announced that it will be giving the go-ahead for another round of COVID-19 boosters for people aged 50 and older, and for those who are immunocompromised. Those eligible can now receive another booster of either Moderna or Pfizer-BioNTech at least four months after their last dose. With the announcement of a fourth-round, many people are wondering, “do I need another booster?”

Health officials argue that the protection provided by the COVID vaccine booster shots wanes over time. They also are concerned about people considered to be at the highest risk of getting severe COVID. However, the Centers for Disease Control and Prevention (CDC) hasn’t made it clear how urgently people should be getting their second boosters. The agency says that these groups are “eligible” for the boosters, but stopped short of saying that they should get them. Furthermore, some infectious disease experts say that not everyone who is in this “at-risk” group needs another booster at the moment.

All this is to say if you’re wondering, “do I need a booster?” there are a few things you should think about. Let’s start by first understanding what a booster is, and why it may be necessary.

What Are Boosters?

What Are Boosters?

In its most basic definition, a booster shot is an additional dose of a vaccine given after the protection provided by the original shot(s) has begun to decrease over time. This extra “boost” given by the booster shot helps people maintain strong protection against severe illness, hospitalization, and death. In the case of the two main COVID-19 vaccines, Moderna and Pfizer, the initial protection given was very powerful. However, that protection wanes after fives months for both, and only after two months for the Johnson & Johnson vaccine.

Two studies released by the CDC (one conducted in April–December 2021 and the other from August 2021–to January 2022) show that being fully vaccinated (meaning both doses of the Pfizer or Moderna vaccine or one Johnson & Johnson vaccine) plus receiving a booster provides greater protection from severe disease, hospitalization, and death due to COVID-19 compared to only being fully vaccinated.

A third study, published in the Journal of the American Medical Association, shows similar results. The research also indicates that the booster offers greater protection against the delta and omicron variants than being fully vaccinated or not vaccinated at all.

The CDC recommends that people who are fully vaccinated get a booster dose when they are eligible and that they stay up to date with COVID-19 vaccinations.

Are Boosters Normal?

One of the biggest pieces of misinformation surrounding the COVID-19 vaccines is their effectiveness. Purveyors of vaccine misinformation point to the need for booster shots as a reason why the shots are “useless” or “ineffective.” This claim is not only wildly false, but it’s dangerous as well. Misinformation about public health measures such as vaccines can carry serious consequences and can lead to widespread, false beliefs that may cause some to remain unvaccinated. So, let’s take a look at why boosters are normal, and why they may be necessary.

Most vaccines that are given in the United States require several doses to render immunity. While boosters are a very common way to administer enhanced immunity, their necessity depends on the type of vaccine.

One dose of certain live vaccines, vaccines that carry a live version of the virus, can offer you a lifetime of protection against disease. Other live vaccines may require two doses, such as the measles, mumps, and rubella (MMR) and chickenpox vaccines. For these vaccines, children typically get their first dose at 12-15 months of age, and then their second between the ages of 4-6.

Other vaccines, like inactivated vaccines, often require several doses over time to help your body maintain immunity. Boosters are currently recommended for many vaccines, likely one you’ve received in your lifetime. One common vaccine that requires frequent boosters is the tetanus vaccine, which is a series of vaccines given every ten years. Other vaccines that require boosters may include the following:

  • Pneumococcal: three doses at two, four, and six months; boosters at 12 to15 months.
  • Haemophilus influenzae type b (Hib): two doses by four months; boosters at 12 to 15 months
  • Polio: three doses by 18 months; boosters at four to six years—depending on which vaccine is used.

Do I Need a Booster? Four Things to Consider

Do I Need a Booster? Four Things to Consider

Now that we’ve covered the basics of what boosters are, and why they’re necessary, it’s time to answer the question you likely came here for: “Do I need a booster?” While the U.S. Food and Drug Administration (FDA) has authorized a second booster for Americans aged 50 and older and those with certain immune conditions, our evidence on a fourth round of vaccines is not complete. This means that whether or not a booster is right for you depends on several factors. Below, we’ll take a look at these four factors, and help you understand if you need a booster.

Time Since Last Booster or Recent Infection

As previously mentioned, one of the most important things to consider when determining whether or not a booster is right for you is timing. We’ve known for some time that vaccine efficacy wanes around the five-month mark, which is even more apparent for those over the age of 50 or who are immunocompromised. For these reasons, the second booster is being recommended for these individuals four months after their first booster.

This evidence of waning immunity comes from a recent analysis conducted by the CDC of COVID-19 emergency room visits and hospitalizations during the latest omicron spike. The analysis found that two months after a third dose, people were 91% protected against hospitalization, but by four months, that protection dropped down to about 78%.

This means that people who have received their first booster three to six months ago likely have limited protection against current infections. Currently, the rate of viral infections has decreased significantly since the peaks in January. However, there are signs that infections are rising in some areas.

There’s also another factor regarding timing that you should consider when thinking about getting a second booster: a recent infection. If you’re fully vaccinated, have had your first booster, and you’ve tested positive for COVID-19, some researchers believe that it’s reasonable to wait, as a recent infection does provide some level of added immunity. It should be noted, however, that immunity via infection isn’t the same for everyone, and is not easily measurable like that of a vaccine.

Are You Immunocompromised?

One of the more pressing reasons to consider when asking, “do I need a booster?” is whether or not you are immunocompromised. Health officials are and have been since the beginning of the pandemic, particularly concerned about immune-compromised people. This is because these individuals’ immune responses to the vaccine tend to wane faster than others. They are also at a significantly higher risk of getting severely ill or dying from COVID-19.

It is for these reasons that anyone over the age of 12 with certain immunocompromised conditions is now eligible to receive an additional booster of the Pfizer vaccine, and anyone over 18 can receive an additional booster of Moderna.

This includes people who have undergone solid organ transplants, or who are living with conditions that have a similar level of immunocompromised.

Age Increases Risk of Serious Illness

Your risk of serious illness, hospitalization, and death from COVID-19 tracks with age. A recent study conducted in Israel on people 60 and older found that rates of COVID-19 infection and serious illness were lower in people who had a fourth dose of the Pfizer vaccine compared to three shots.

It’s not just the U.S. that has targeted additional boosters for older people. Germany has authorized the fourth shot for people over 70. The U.K. is targeting people over the age of 75 and Sweden is giving fourth shots to people over 80. While some researchers say the U.S. is “jumping the gun” by recommending boosters for everyone over 50, the correlation between age and risk remains clear.

Boosters provide increased immunity against COVID-19, and in doing so decrease your risk of infection. As the risk of serious infection and death tracks with age, those over 50 may want to consider getting their second booster.

Do You Have Any Underlying Conditions?

Certain medical conditions have also been known to increase your risk of serious illness and death from COVID-19. It is for this specific reason that the FDA decided to authorize a second booster for individuals over 50.

About one-third of people within the age range of 50 to 65 have significant comorbidities. These include conditions such as heart disease, lung disease, obesity, and diabetes, all of which also put you at higher risk for serious illness and death from COVID-19. By choosing ages 50 and up, researchers believe they can capture the population that might benefit most from a second booster.

Bottom Line: Do I Need a Booster?

So, do you need a booster? The reality is that short of a full-on CDC recommendation, the decision of whether or not you should get a booster is up to you. Some infectious disease experts say that some people might want to wait to get a booster until a time when cases start to rise in their community and they need the added protection more urgently. Others say that more effective vaccines may be on the horizon, which could offer more protection against new variants.

That said, the available vaccines are safe, effective, and offer protection against serious illness and death. If you are over the age of 50, or if you are immunocompromised, you may benefit from the added immunity that a second booster gives you. Those with underlying health conditions could also benefit from a fourth round, although it’s always important to talk with your doctor to make sure vaccines are safe for you.

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    • From what I could gather (from various organizations and healthcare professionals) if you are over 50, or immunocompromised, or if you have certain medical conditions that may make infection particularly dangerous, a second booster may be right for you. As always, it’s a decision best made with your doctor!


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