Navigating the World of Boosters & Mix-and-Match Vaccines
What to do (and when) as we head into cold, flu, and COVID season
In the last 48 hours, eligibility to receive a booster shot has expanded (cheers to those who received Moderna and J&J), and we’ve been given the green light to mix-and-match vaccines. Meaning if you received a J&J vaccine previously, you can now boost your immunity with either a J&J, Pfizer, or Moderna vaccine. You can also mix-and-match Pfizer & Moderna vaccines.
Before diving into the details, here are the top 5 things you need to know as we head into the last week of October (and #5 is the most important) —
Everyone 6 months and older needs a flu vaccine (go get yours today!)
Everyone 12 years of age and older needs a COVID vaccine
Everyone who originally received the J&J COVID vaccine needs a booster
Many of us who received Pfizer or Moderna need a COVID vaccine booster
Vaccines save lives! Vaccines prevent disease! Vaccines are safe!
Authorization for COVID booster shots and mixing-and-matching vaccines (by manufacturer) was granted by FDA and CDC. Both agencies have reviewed clinical trial as well as real-world observational data during the last two weeks, and they have unanimously concluded that COVID vaccines are —
Safe
Effective at preventing severe disease, hospitalizations, and death
While the vaccines are effective, an increasing number of breakthrough infections (and subsequent hospitalizations and deaths), have led health authorities to recommend booster shots for certain groups of individuals. These booster shots are designed to boost/increase/energize the immune system and sustain the body’s ability to fight off an infection caused by the SARS-CoV-2 virus.
So… who is eligible for a booster shot?
Across the board, booster shots are only authorized for individuals who are 18 years of age and older (the 12-17-year-olds who received the Pfizer vaccine are not eligible for booster shots). If you are at least 18 years old, here is the decision tree to determine if you are eligible to receive a booster dose…
Step 1: Identify which vaccine you received originally — Pfizer, Moderna, or J&J
If you received Pfizer or Moderna, determine if you received your second shot at least six months ago. If so — you can get a booster shot if and only if you can answer YES to one of the following three questions:
Are you 65 years of age or older?
Are you 18+ and living in a long-term care facility?
Are you 18+ and have an underlying health condition?
Are you 18+ and working in a job where exposure to the virus is high?
If you answered YES to any one of the four questions above AND it has been at least 6 months since your second Pfizer or Moderna shot, you are eligible for a booster dose.
If you received the J&J vaccine at least 60 days ago (2 months), you are eligible for a booster dose.
Read: EVERYONE who received a J&J shot should get a booster dose. You can get your booster dose 60 days after your primary/first shot.
Step 2: if you are eligible, what vaccine should you get?
Now that you can mix-and-match vaccines, what’s the best course of action?
I want to preface my response to this question by stating (1) this is NOT medical advice (go to your primary care provider for that); and (2) all of the recommendations are based on a single study completed by NIH and published last week (meaning, there is still a lot to learn, but we have solid evidence to guide the recommendations). From this study, we have learned that mixing vaccines is safe — you can get Pfizer and then be boosted with Moderna or J&J and it is safe; start with Modern and get Pfizer or J&J and it is safe; start with J&J and get boosted with Pfizer or Moderna and it is safe.
The vaccines are SAFE. Booster doses are SAFE.
In terms of the effectiveness of a combination/mixing vaccines — the greatest increase in immunity was experienced by individuals who received their J&J shot and were then boosted with either Pfizer or Moderna. The combination of J&J + one of the mRNA vaccines as a booster was really effective at producing immunity.
If I was originally vaccinated with J&J, I would definitely be planning to get a booster dose of Pfizer or Moderna.
For those of us who received Moderna or Pfizer originally — if you qualify for a booster (based on the criteria above), go get a booster shot! Make getting a booster convenient; meaning get either Pfizer or Moderna, whatever your nearest pharmacy or clinic is offering. I would NOT plan on getting a booster dose of J&J (following a primary series of either Pfizer or Moderna). The immune response of the combination of Pfizer/Moderna followed by a J&J boost was minimal compared to a Pfizer/Moderna boost.
The bottom line is boosters will increase immunity. And Pfizer/Moderna booster shots produce the strongest immune response (regardless of what vaccine you received originally).
I want to end this post with a clear message about slowing the spread of disease and seeing the pandemic come to an end…
We canNOT booster-shot our way out of the pandemic.
The way out of the pandemic is tied to increasing the number of individuals who are fully vaccinated (2 doses of Pfizer/Moderna or 1 dose of J&J).
And as we head into cold, flu, and COVID season — continue to wear a mask in indoor spaces. Gather outdoors when possible. Wash your hands. And stay home if you are sick!