Doctors: Talk to us to decide on booster
Get shot or skip? Mix or match vaccines? Guidance can be confusing.


Charlie Michael of the Tucker area in DeKalb County felt like he had won the lottery when he secured a one-dose Johnson & Johnson COVID-19 vaccine in March, at a time when vaccines were scarcely available. But since then, he has been feeling less lucky and more vulnerable, anxious to get a booster dose of the vaccine as soon as possible.

The final approval came from the director of the Centers for Disease Control and Prevention late Thursday, allowing boosters for recipients of Moderna or J&J vaccines and allowing providers to mix-and-match booster doses.

Now, more so than the first arrival of vaccines, the question about who needs a booster and which brand will require an individual answer. Boosters have also been controversial because some feel that they are drawing attention and vaccine away from the more urgent problem of people who aren’t vaccinated at all.

That leaves Michael, a 40-something professor at Georgia Gwinnett College, with a tough decision to make. “I feel a little rudderless about what I am supposed to do,” Michael said.

Many people who received Pfizer vaccinations earlier this year were already eligible for a booster. When CDC Director Dr. Rochelle Walensky signed off on boosters for millions more who got Moderna and J&J vaccines, she also said the agency will allow “mixing and matching” of the three vaccines. It was a move intended to make it easier for people to find vaccines and for doctors or pharmacies to avoid wasting vaccine if they couldn’t use an entire vial immediately.

“I know this latest guidance can be confusing for people and a little bit perplexing,” said Dr. Thomas Bat, chief executive officer of North Atlanta Primary Care, which has 16 clinics throughout metro Atlanta.

“What we know continues to evolve and can change, just like the virus. My advice for people is to find a primary doctor you can trust and who you can talk to about this.”

Who really needs one?

There are still restrictions on who qualifies for a booster and questions about who really needs one. But when it comes to the single-shot J&J vaccine, a COVID-19 booster is recommended for adults at least two months after their vaccination. In Georgia, only about 265,000 people or about 5% of the total people vaccinated received a J&J shot.

Starting six months after their last Pfizer or Moderna vaccination, adults older than 65, adults who are 50 to 65 with certain medical conditions, and those who reside in long-term care settings should receive a single booster dose, according to the CDC.

For adults ages 18 to 49 with a wide range of medical conditions and adults whose jobs regularly expose them to the virus, such as health care workers, the CDC says they “can” get the booster but should make a decision after considering their individual risk.

The Georgia Department of Public Health said there are no supply issues with vaccines, and people could get them beginning Friday.

Ongoing tracking of cases show all three vaccines are working well to prevent serious illness or death, even when tested against the delta variant. However, the Pfizer and Moderna vaccines show a gradually waning protection, and J&J has never shown protection as robust as the other two brands. With an additional dose, all three vaccines show a boost in protection.

A CDC study published last month found that the J&J vaccine was 71% effective in protecting recipients against hospitalization, compared with 88% for Pfizer and 93% for Moderna.

Both the Pfizer and the Moderna vaccines are considered “messenger RNA” shots, which means they teach the body to produce a protein that mimics the coronavirus, triggering an immune response. The J&J vaccine uses a weakened common cold virus modified to carry genetic information about the new coronavirus.

Some of the CDC advisers this week cited preliminary data from an ongoing National Institutes of Health study that suggests recipients who initially had a J&J shot get a bigger boost of antibodies from a booster of either Pfizer or Moderna. But the CDC panel didn’t explicitly recommend anyone get a different brand than they started with, only leaving the option open. 

Advice of a doctor

Dr. Jay Varkey, an associate professor of infectious diseases at Emory University School of Medicine, lauded the ability to be flexible with mixing the vaccines, which can offer some practical benefits.

He added he doesn’t believe there is enough conclusive data that points to any particular combination of vaccines being better than any other for enhancing protection.

But Bat said the mixing of the vaccines has been shown to be safe and can potentially yield better protection. He said if his 25-year-old son, who took the J&J vaccine, decides to get a booster dose, he would urge him to take a Moderna vaccine. But he wouldn’t necessarily make the same recommendation for all of his patients.

Dr. Cecil Bennett, medical director of a primary care center in Newnan and an adjunct professor at Morehouse School of Medicine’s Family Medicine Program, said based on the research and information available about the vaccines, he would recommend patients who got a J&J vaccine to get a dose of an mRNA vaccine (Pfizer or Moderna) as a booster.

Bennett said he tries to minimize guesswork on who should get a booster by encouraging his patients to get an antibody test before making a decision.

But other physicians argue antibody tests don’t paint a full picture of immunity. An antibody test can’t tell you if you’re protected against serious illness, symptomatic illness or infection.

Bennett acknowledged many questions remain about the best approach with boosters.

“Some questions take time to answer, and there is no getting around the timeline here,” said Bennett. “Usually, these types of questions like who and when you need a booster, these are answered over several years. But we are in the middle of a pandemic. We are reporting it as we get it.”

Public health experts stress evidence to date shows that all the vaccines authorized for use in the U.S. continue to protect people well against severe COVID- 19, including hospitalization and death, even as the highly contagious delta variant swept through the country.

But breakthrough infections have been on the rise.

“The data that we have today show that these vaccinations are performing excellent so far — even including the delta variant — at what they were designed to do, which is prevent severe illness and death,” Varkey said at an Emory news briefing.

Varkey encourages people younger than 65 without medical conditions to talk to their doctors about the risks and benefits of getting a booster dose.

He said he realizes people are deciding for themselves if their risk warrants getting a booster shot.

Even so, at this time, it doesn’t make sense for everyone to get a booster.

For example, he cautioned that a young, healthy and fully vaccinated adult should weigh the “very, very low” risk of a severe case of COVID-19 against a marginal gain to be had from a booster, which, while is considered safe, doesn’t come with zero risk. “Any medication, any intervention, has potential side effects so it’s important we use these strategically and not boost people willy-nilly.”