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Nov. 29, 2021, 7:10 p.m. EST

Confused about whether to get a COVID booster? Here’s what to know

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By Carina Storrs

This article is reprinted by permission from  .

Chris Carlee, a 70-year-old retired nurse living in Clearwater, Fla., worked hard to get the COVID-19 vaccine back in March. She is not a morning person, but woke up hours earlier than usual for several days to join online appointment sites before finally snagging a spot to get the Pfizer /zigman2/quotes/202877789/composite PFE +2.39% vaccine.

But now Carlee says she is “on the fence” about whether to get a third COVID-19 shot and is waiting to talk with her doctor about the booster. Her main qualm is that she has not seen as much data about the safety and effectiveness of boosters as she did for the first two shots of the Pfizer and Moderna /zigman2/quotes/205619834/composite MRNA -3.22% vaccines when the U.S. Food and Drug Administration authorized them last December.

In general, doctors say that older people have been eager to get COVID-19 vaccinations, as well as boosters. Nearly  86% of Americans 65 and older are now fully vaccinated—meaning they have had two shots of Pfizer or Moderna or one shot of the Johnson & Johnson /zigman2/quotes/201724570/composite JNJ +1.27% vaccine — compared with 70% of Americans 18 and older. And 32% of Americans 65 and older have received a booster in just the  two   months  since the Centers for Disease Control and Prevention (CDC) recommended this age group get an additional dose six months after the initial immunization.

On Monday, the CDC strengthened their recommendation , saying everyone 18 and older who’s been vaccinated should get the COVID booster.

However, many older people may want to talk with their doctor, just as Carlee does, before getting a booster.

“I don’t think it’s vaccine hesitancy that is driving it, I think it is just confusion,” says Dr. Preeti Malani, chief health officer and infectious disease physician at the University of Michigan. COVID-19 fatigue and concerns about feeling rundown after the booster may also play a part. To counter these barriers, doctors are trying to convey some key points about getting a booster.

Also see: Christmas markets from Frankfurt to Budapest warily welcome holiday season amid COVID surges

Back to square one without the booster

“The main message I am trying to communicate to older patients is that they are back to square one, and back to where they were before the vaccine,” says Dr. Mark Supiano, professor and chief of geriatrics at the University of Utah. He explains that people 65 and older usually have lower antibody levels after the vaccination, and the levels  drop   faster .

Lower antibody levels may be part of the reason that older people are more likely to have serious COVID-19 breakthrough infections, ones that occur after being fully vaccinated. According to the CDC, nearly 17,000 fully vaccinated people were hospitalized because of COVID-19 as of early October and 67% of them were 65 and older. This age group also accounted for 86% of the approximately 6,600 deaths due to breakthrough infections.

Data shows boosters are safe and effective

“We know additional doses are safe,” Malani says. “The drive to get vaccinated probably has more risk than the vaccine,” she adds.

In studies of dozens of people 65 and older who got boosters of the  PfizerModerna  and  Johnson & Johnson  vaccines, which the FDA reviewed to decide whether to authorize additional doses, side effects were similar to those seen after the first doses — mostly pain at the injection site, fatigue and headache.

Furthermore, concerning side effects have not been seen among the thousands of participants in COVID-19 vaccine  clinical   trials  who’ve received  boosters . Or, Malani says, among the millions of Americans who’ve received boosters so far.

As for the effectiveness of COVID-19 boosters, Supiano notes that we know enough to act now, even though “the evidence base is not as robust as it is for the primary vaccines.”

Related: Face masks and distancing are most effective measures in reducing COVID-19 spread, study finds, as experts clamor for U.S. to expand booster program

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