These Are the People Who Should Get a Second COVID Booster Shot

Americans 60 and older should get a second booster of Pfizer or Moderna's mRNA vaccine, according to Dr. Ashish K. Jha, the White House's COVID-19 response coordinator. 

Jha, who was appointed by President Joe Biden in March, said April 17 on Fox News Sunday that there is "pretty compelling" evidence from Israeli studies that a fourth shot notably reduced the chance of infection, serious illness and deaths among those 60 and up.

The US Food and Drug Administration and the Centers for Disease Control and Prevention signed off on a second COVID booster shot for Americans 50 and older on March 29, as well as for individuals with compromised immune systems.

"The data out of Israel is pretty compelling for people over 60," Jha said. People in that demographic who got a second booster four months after their first "saw a substantial reduction -- not just in infections, but in deaths," he added. "So I think people over 60 should be getting it."

Does that mean anyone eligible for another COVID shot should rush out and get it? And will the FDA eventually authorize a second booster for all adults? Read on to find out what the experts say about the second vaccine booster, including if it's necessary for everyone who's eligible, when to schedule it and if there are any drawbacks.

Who is eligible for a fourth COVID shot?

The FDA has authorized the following groups to get a second booster shot of either Pfizer-BioNTech's Comirnaty or Moderna's Spikevax vaccine.

• Anyone 50 and older.
• People 18 and older who are immunocompromised or have other specific health issues have been approved for a second booster of Moderna's vaccine.
• People 12 and older who meet the same criteria can get another booster of Pfizer's vaccine.
• Adults who received a primary shot and booster dose of Johnson & Johnson's COVID-19 vaccine can now receive a second booster of an mRNA vaccine. 

Should people under 60 who are eligible get another booster?

The value of the additional jab, especially in younger and healthier subjects, isn't as clear-cut. The preliminary studies in Israel found that it decreased the odds of hospitalization and death among elderly patients when the omicron mutation was predominant. But the subjects were between 60 and 100 years old. It might not be as critical for a robust 50-year-old. 
Speaking with ABC News' George Stephanopoulos on April 17, Jha said that a second booster shot for Americans between 50 and 59 "is a much closer call." People in that demographic may want to consult their health-care provider to see if they would benefit, Jha said.
"There is a difference between somebody who is 51 and otherwise healthy without any major medical problems and somebody who is 85 and has multiple medical problems," Dr. Prathit Kulkarni, an infectious disease expert at Houston's Baylor College of Medicine, told NBC News in March.

"Their risk profile from potentially having a bad outcome from COVID-19 is fairly different," Kulkarni added. "The bottom line is, it depends on individual risk profile: What is your age? What are your comorbidities?" 

According to the CDC, those who got a second booster were seven times less likely to be hospitalized -- and 21 times less likely to die from COVID-19 -- than the unvaccinated. But in real numbers, the risk -- even for the elderly -- is much smaller to begin with if you've had a single booster. 

In the Israeli study, less than 0.1% of patients with three shots died. That percent dipped to 0.03% for those who got the fourth shot.

Dr. Eric Topol, a professor of molecular medicine at Scripps Research, wrote March 29 in his Substack newsletter Ground Truth that he felt another booster makes sense if you're 50 or older, it's been at least four to six months since your last booster, you tolerated the other shots well and you're concerned about the BA.2 variant where you live.

There is one caveat, he added: Individuals who had three doses of an mRNA vaccine and still got a breakthrough case of COVID don't need another booster.  "It's better than a booster," Topol told CNET. "You have hybrid immunity."

Where can I get a second booster shot? 

Additional vaccine boosters are available at pharmacies, health care clinics and doctor's offices, much as previous shots were:

• Walgreens is now offering additional Pfizer and Moderna COVID-19 vaccine boosters to eligible customers on a walk-in basis.
• CVS has an online appointment portal to schedule your second booster. Eligible individuals can also walk in for their shots, including at on-site CVS pharmacy locations at Target, subject to local demand.
• Grocery chain Albertsons is also offering second-round boosters to walk-ins or scheduled appointments at more than 1,700 Albertsons, Safeway, Vons, Jewel-Osco, Shaw's, Acme, Tom Thumb, Randalls, United Supermarkets, Pavilions, Star Market, Haggen and Carrs locations.

Should I get the shot right away?

There's no clear answer on whether those eligible for a second booster need to rush out for one. Dr. Peter Marks, director of the FDA's Center for Biologics Evaluation and Research, told reporters he would advise older relatives to get another booster right away "because of the higher level of protection." 

"COVID-19 has had a really disproportionate impact on people 65 and older," he said. "One in 100 [seniors] are not with us today who were with us before the pandemic because of COVID-19."

But vaccine efficacy wanes over time, so getting a booster now means you won't have maximum protection in six or seven months. The BA.2 variant, dubbed "stealth omicron," is now the leading strain in the US, but how serious it will become -- and how quickly -- remains to be seen.

Dr. Monica Gandhi, an infectious disease expert and professor of medicine at the University of California, San Francisco, told CNET it might make sense to plan your booster around respiratory pathogen season in the fall, when cases of COVID will likely rise. 

"I'd rather my parents get the booster in late summer, so they're fully protected in the fall," Gandhi said. 

Topol said there are many factors to consider when scheduling your next booster.

"If you're younger, healthy and in a place where the virus circulation is very low, it's less critical," Topol told CNET. "But if you're somewhere where infections are raging -- or if you're traveling -- it makes sense to do it now. It's like a coupon that expires. When do you use it?" 

Will the FDA eventually approve a fourth shot for everyone?

Numerous studies indicate the effectiveness of COVID-19 vaccines decreases over time, and health officials continue to move toward recommending a second booster shot for the general population. 

"The CDC, in collaboration with FDA and our public health partners, will continue to evaluate the need for additional booster doses for all Americans," CDC Director Dr. Rochelle Walensky said in a release in late March.

The FDA is potentially preparing to authorize another dose of mRNA vaccine for the general population in the fall, The Wall Street Journal reported in February.

But Gandhi said the US doesn't have strong data yet for people under 65 benefiting from a second booster. Germany has only approved it for people over 70, the UK for those over 75 and Sweden for people over 80. 

In an op-ed on Medpage in late March, Gandhi and emergency physician Dr. Michael Daignault said there needs to be more clarity in the government's booster strategy.

"We are concerned that despite continued promises to 'follow the science,' our health agencies, including the FDA and CDC, and the Biden administration continue to act without clearly articulating strategic, evidence-based goals for both the vaccine and subsequent boosters," they wrote.

Are there any drawbacks to getting another dose of vaccine?

Scientists have discussed the possibility of immunity fatigue, where the body is overexposed to a vaccine and stops reacting to it. At this point, it's only a theoretical problem. But UCSF's Gandhi said, "This many shots in such a short time -- it's unprecedented."

"There's also the idea of 'original antigenic sin,' where you keep training your T cells to fight against the original strain, but we keep getting newer and newer variants." As a result, your system is less able to fight off coronavirus infection.

B cells, another kind of immune cell, can adapt to whatever COVID variant they face, Gandhi said. But it's not clear T cells have that versatility. "It's still theoretical, but I wouldn't get a booster unless I really felt it had benefit," she added.

Will we keep needing more boosters? 

The nature of this pandemic is unprecedented, Topol said, in part because of the speed at which scientists have been able to develop vaccines and treatments. So it's hard to look into the future and know if regular boosters will be required, either to prevent infection or stave off hospitalization or death.

"We need more tools," Topol told CNET. "We need a pan-coronavirus vaccine," that can deter multiple viruses, not just SARS-CoV-2. 

"If we had that we wouldn't have to futz around with each letter" variant, he added. "If we had Paxlovid in large quantities available everywhere, we wouldn't need repeated boosters," he said, referring to the COVID antiviral pill.