The most crucial lifesaving weapon we have in this epidemic is vaccination against the virus that causes COVID-19. Fortunately, the vaccines that have been approved in the United States have proven to be extremely safe and effective. And we've understood since the beginning that the powerful protection they provide would eventually wear off. But has protection deteriorated to the point that booster doses are required? This potential has been highlighted by studies published in the last several months by researchers in the UK, Israel, and the US (reviewed here and here), and Israel and the UK have already begun aggressive booster programs.  

First and foremost: Everyone should get vaccinated:  

As you may be aware, the CDC and FDA have conducted an assessment of the necessity, safety, and impact of the vaccine. Although both agencies will examine data for Moderna and Johnson & Johnson in the weeks and months ahead, that is the only booster shot being supplied thus far. (I'll get to Pfizer's recommendations later.) But first, don't forget this: vaccinating the unvaccinated should take precedence over giving booster shots to people who have already been vaccinated. This is true for persons in the United States who have been unable or unwilling to receive the vaccine, as well as people in other countries with limited vaccine access. Not only would expanding the pool of those who received initial immunizations save more lives than marketing boosters but it would also lower COVID-related health care disparities between rich and poorer countries. The World Health Organization (WHO) has advocated for a suspension of booster shots. Meanwhile, the Biden administration has pledged to provide another half-billion vaccine to low-vaccination-rate countries, bringing the total US commitment to 1.1 billion doses. Starting a booster program in the United States and assisting other nations in getting their citizens vaccinated are not mutually exclusive, according to the administration.  

Is there any distinction between a booster shot and a third shot?  

It's not a ruse: not all additional vaccine doses are boosters. The FDA approved a third dosage of the Pfizer or Moderna vaccine for immunocompromised persons in August 2021. This includes persons living with HIV and those undergoing immune-suppressing cancer treatment. The extra dose isn't considered a booster for them; it's part of their original immunization series.  

When it comes to vaccine boosters, getting the timing right is crucial:

Vaccine boosters should be given no sooner than is necessary, but well before widespread protective immunity begins to wane. The dangers of waiting too long are clear: when immunity declines, infection, serious disease, and death rates may begin to climb.  

However, there are drawbacks to giving boosters too early:  

Side effects may be more common. While studies to date demonstrate that boosters are safe, long-term data is still lacking. The advantage may be insignificant. If the majority of people are still protected by their first vaccines, it may be best to hold off on boosters.  

Future versions may not be covered by current boosters. Boosters may be changed to cover new varieties of concerns that emerge in the following months.  

It's possible that delaying a booster will result in a higher immunological response. "You get far more bang out of the shot if you allow the immune response to evolve over a few months," Dr. Anthony Fauci recently said.  

Pfizer/BioNTech vaccination booster recommendations:  

The CDC and FDA have determined that booster shots are required for some Pfizer/BioNTech vaccine recipients. For those who are on their second dose, a booster is required at least six months later.    

• 18 to 64 years old and at high risk of serious COVID sicknesses, such as those with chronic lung disease, cancer, or diabetes who live or work in a high-exposure situation, such as residents of long-term care institutions, healthcare professionals, teachers, and daycare personnel, grocery workers, and convicts.  
• Pfizer/BioNTech boosters are not currently approved for the general public. This is because the early doses appear to provide adequate protection against serious sickness and death. 

 Also read Blocking Immune System Pathway May Stop COVID-19 Infection and Prevent Severe Organ Damage- says study

There are numerous unknowns:

The publication of these latest Pfizer vaccination booster recommendations raises several questions:  

• How reliable is the data on safety? Boosters appear to be safe according to current reports, but further research and real-world data are needed.  
• How soon will decisions on the approval of Moderna and Johnson & Johnson boosters be made?  
• Should all boosters be the same vaccine as the initial regimen, or can you get more protection by mixing vaccines? Unfortunately, some people mix vaccines on their own, sometimes falsely claiming not to have received a COVID vaccine to receive another variety. However, no strong evidence exists to determine the dangers or benefits of this strategy. 
• Will the booster doses are identical to the first doses? So far, the Pfizer/BioNTech vaccine has received a positive response. However, once approved, the Moderna booster will most likely be for a half-dose.  
• Will the boosters be changed to defend against new, dangerous variants?  
• Will there be a need for more boosters in the future? If yes, how often do you do it?  

In the next weeks and months, expect answers to these questions.  

What comes next?  

The FDA and CDC are expected to alter and broaden booster guidelines based on current research reviews and analysis. Meanwhile, we should step up our efforts to vaccinate those who have not yet been vaccinated. Boosters can be useful in a variety of situations. 

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