With Pfizer vaccine boosters now available, what's next for Moderna and J&J? What to know

The CDC has approved eligibility guidelines for the Pfizer vaccine booster. Recommendations for Moderna and Johnson & Johnson could come soon.

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US health officials are recommending that adults get a booster shot.

Sarah Tew/CNET

Following this week's recommendation from the Centers for Disease Control and Prevention, certain older Americans and those considered at high risk for complications from COVID-19 who received two doses of the Pfizer-BioNTech vaccine will now qualify for booster shots. While there hasn't yet been a determination on additional doses of the Moderna and Johnson & Johnson vaccines, those vaccines may not be too far behind in the approval process. 

The push for vaccine boosters is based on research that suggests the effectiveness of the vaccines can decline over time. An additional shot provides enhanced protection against the surging COVID-19 delta variant, especially for those most vulnerable for infection. 

Studies show that the COVID-19 vaccines available in the US continue to be highly effective in preventing hospitalization. Over the summer, as the delta variant took hold, the number of cases, hospitalizations and deaths from COVID-19 surged in the US. Those who are unvaccinated have accounted for nearly all the hospitalizations and deaths -- over 97% as of July.

The White House has started the process of rolling out a plan for boosters. Read on for what we know about COVID-19 booster shots today, including who can get the Pfizer boosters with the CDC's most recent recommendation. We'll also explain how they relate to breakthrough infections and what the controversy has been surrounding the shots. Here's more about whether you can mix and match COVID vaccine boosters and the latest on COVID vaccine mandates. We've updated this story.

Who is eligible for a Pfizer COVID booster shot now?

If you are fully vaccinated with the Pfizer vaccine and received the second dose at least six months ago, you might be eligible for a booster shot now. The new CDC guidelines apply just to those vaccinated with the Pfizer vaccine and not for those who received the Moderna or Johnson & Johnson vaccines. A booster recommendation for the other two vaccines is expected in the coming weeks, US Surgeon General Vivek Murthy said on Friday.

Here's who is currently eligible among Pfizer recipients: 

  • Those aged 65 and older
  • Residents in long-term care facilities
  • Individuals 18 to 64 years of age with an underlying medical condition
  • Individuals 18 to 64 years who are at increased risk because of their job

The Pfizer vaccine is the first to receive FDA approval, while the Moderna and Johnson & Johnson vaccines are available under an emergency use authorization. For children ages 12 to 15, Pfizer's vaccine is authorized for emergency use.

Who is eligible for either a Pfizer or Moderna booster shot?

People with weakened immune systems who received the Pfizer or Moderna vaccines can also get their third dose of a COVID-19 vaccine if it's been at least four weeks since the second dose (and if they're 18 and older). The Food and Drug Administration and the CDC haven't yet authorized an additional dose of the Johnson & Johnson vaccine for those with compromised immune systems. 

About 3% of US adults are immunocompromised, according to the CDC, but research suggests they account for about 44% of hospitalized breakthrough cases of COVID-19. Not only are they more likely to get very ill from COVID-19, they also have a lower antibody response to vaccines and are at a higher risk of transmitting the virus. The list of people includes solid-organ transplant recipients and people who have an "equivalent level of immunocompromise" and who have a reduced ability to fight off infections. 

Here's a list of people the CDC recommends get an extra dose of the Pfizer or Moderna vaccine: 

  • Those with advanced or untreated HIV infection.
  • Cancer patients and transplant recipients who are taking certain immunosuppressive drugs.
  • Those receiving active cancer treatment for tumors or cancers of the blood.
  • Those with moderate or severe primary immunodeficiency. 
  • Patients being treated with high-dose corticosteroids or other drugs that may suppress immune response. 
  • People who received a stem cell transplant within the last two years and are taking certain drugs. The CDC says to talk to your medical provider about your health condition and whether a third shot is appropriate. 

If you're unsure whether you're qualified, the CDC says to talk to your medical provider about your health condition and whether a third dose is appropriate. 

Didn't the Biden administration push for everyone to get a booster shot?

In August, health officials in the Biden administration recommended an additional shot for all Americans 18 and over who are fully vaccinated with the Pfizer or Moderna shots, proposing a booster eight months after being fully vaccinated. 

"We believe that that third dose will ultimately be needed to provide the fullest and continual extent of protection that we think people need from the virus," Murthy said. "Our plan is to stay ahead of this virus by being prepared to offer COVID-19 booster shots to fully vaccinated adults 18 years and older." 

This week, however, both the FDA and CDC narrowed the guidelines for those who could receive a Pfizer shot to those who are most vulnerable.

Are booster shots needed right now?

Making the case for starting up the booster program now, Murthy said, "Recent data makes clear that protection against mild and moderate disease has decreased over time," likely due to both waning immunity and the strength of the widespread delta variant.

However, in The Lancet, a group of scientists said, "Boosting might ultimately be needed in the general population because of waning immunity" but the vaccines continue to be effective against COVID-19 and the delta variant. "Current evidence does not, therefore, appear to show a need for boosting in the general population," they wrote. Instead, the scientists recommend using the current supply of vaccines for those with a risk of serious disease and for those who have not yet received any vaccine.

What about Johnson & Johnson or Moderna boosters?

After early studies indicated the maximum protection of COVID-19 vaccines tends to wane after six to eight months, Moderna, Pfizer and Johnson & Johnson each started working on booster shots to bolster immunity. While Pfizer is ahead in the approval process, Moderna could just be a few weeks behind.

Johnson & Johnson announced in a press release on Sept. 21 that a booster dose of the vaccine, given two months after the first shot, was 94% protective against symptomatic COVID-19 in the US and 100% effective against severe COVID-19, which puts it in the same league as Pfizer and Moderna. The company said it would work with public health officials on a plan for a booster shot, but there is no time frame in place. Currently, the one-dose Johnson & Johnson vaccine is available under an emergency use authorization for individuals 18 years of age and older. Here's more detail on J&J boosters

What's happening with COVID-19 breakthrough cases? 

As of July, in the US, breakthrough coronavirus cases caused by the dominant delta variant amount to less than 1% of people who are fully vaccinated. Both the Moderna and Pfizer vaccines have proven to be more than 90% effective against hospitalizations and death. Nonetheless, a CDC study shows that vaccinated people can both contract the highly contagious delta variant and spread it. According to a widely reported internal CDC memo, the delta variant spreads as easily as chicken pox, which is considered more contagious than the flu but less contagious than measles

The surge in new COVID-19 cases is primarily affecting unvaccinated people and causing community spread, and in turn, prompting the return of mask mandates and guidance in hard-hit areas, even for people who have full vaccine protection. The debate over mask use and vaccine boosters underscores how scientists and other health experts continue to grapple with the uncertainties of COVID-19.

Biden press conference

The Biden administration says booster shots will be free.

Screenshot by Corinne Reichert/CNET

What's the controversy with the WHO over booster shots?

The plan for boosters has resulted in a backlash among countries that are struggling to deliver first and second shots to residents. 

Last month, World Health Organization Director-General Tedros Adhanom Ghebreyesus called for a "moratorium" on booster shots in high-income countries, citing the global disparity in vaccine distribution. Of the 4 billion doses administered globally, 80% have gone to high- and upper-middle income countries that make up less than half the world's population, he said. He also called on vaccine producers to prioritize Covax, the world's COVID-19 vaccine distribution program.

At a Sept. 8 news conference, Tedros said that the world's poor shouldn't have to be satisfied with leftovers. "Because manufacturers have prioritized or been legally obliged to fulfill bilateral deals with rich countries willing to pay top dollar, low-income countries have been deprived of the tools to protect their people," he said.

White House Press Secretary Jen Psaki said on Aug. 17 that the US will have enough vaccines to both provide boosters for those who are fully vaccinated in the US and meet the global demand. "We have long planned from enough supply," she said

The US has so far shipped 115 million vaccine doses to 80 different countries, said White House COVID-19 Response Coordinator Jeff Zients. "Our wartime efforts will continue doing everything we can to get even more people vaccinated both here at home and around the world. We can and must do both at the same time because that's what it's going to take to end this pandemic," he said.

Will booster shots be free of cost?

The current one-dose vaccine shot from Johnson & Johnson and two-dose vaccines from Moderna and Pfizer are free to anyone who wants to get vaccinated. And the additional shots will be free too. 

"These booster shots are free," Biden said. "It will be easy. Just show your vaccination card and you'll get a booster. No other ID. No insurance. No state registry requirements."

"It will be just as easy and convenient to get a booster shot as it is to get a first shot today. We have enough vaccine supply for every American," Zients said, adding that those who are eligible will be able to get a booster at roughly 80,000 places across the country, including over 40,000 local pharmacies. Zients said 90% of Americans have a vaccine site within five miles of where they live.

Vaccines.gov provides information, including what vaccines are available at each site and, for many sites, what appointments are open. A toll-free number, 1-800-232-0233, will also be available in over 150 languages. Americans who have already used the text code 438829 or WhatsApp to get vaccine information will automatically receive a text with information on boosters, if and when recommended.

While we watch how the situation develops, here's what we know about the delta variant and info on whether you should continue to wear a mask.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.