Second Booster

Earlier this week, the FDA authorized a second booster dose of COVID-19 vaccine in those ages 50 and over who received their first booster greater than 4 months prior. (See table below.) The CDC followed the announcement with its recommendations, identifying the populations most likely to benefit from the additional booster based on hospitalization rates in the U.S. and preliminary data from countries that provided second boosters to select populations. Young and healthy individuals are less likely to benefit from a second booster and, thus, are not eligible at this time.

Eligibility for a second booster includes the following groups:

• 2^nd booster of Pfizer or Moderna in ages 50+ at least 4 months after 1^st booster of any approved or authorized COVID-19 vaccine.
• 2^nd booster of Pfizer (ages 12+) or Moderna (ages 18+) for those moderately or severely immunocompromised at least 4 months after 1^st booster of any approved or authorized COVID-19 vaccine. The designation of moderately or severely immunocompromised is limited to those receiving treatment for cancer, transplant patients, primary immunodeficiency, advanced HIV, or taking immunosuppressive medications. More information can be found on the CDC website at https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html
• 2^nd booster of Pfizer or Moderna for those 18+ who received Johnson & Johnson for primary series and 1^st booster at least 4 months prior.

The guide below was created after extensive review of supporting data and CDC recommendations on who may benefit from a second booster at this time.

Click chart image to download or print. 

Individuals not eligible and those not falling into the categories above are well protected with a single booster. When immunity wanes or modified vaccine is available, perhaps within this calendar year, it is probable that all adults will be eligible for a second booster. The effort will then focus on defining an optimum timeline for immunization, perhaps mimicking the annual influenza schedule or other regimen. Our goal should include a schedule that is both simple to follow and highly effective at limiting severe cases of COVID-19.

Trey Dobson, MD, is an emergency medicine physician and the chief medical officer at Southwestern Vermont Medical Center, part of Southwestern Vermont Health Care, in Bennington, and the medical director of Dartmouth-Hitchcock Putnam Physicians.