Booster Doses of the COVID-19 Vaccines Are Now Approved for All Adults. What Happens Now?

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  • The CDC and FDA have authorized booster shots of all three COVID-19 vaccines to all American adults who received their last dose of Pfizer or Moderna at least six months ago, and Johnson & Johnson at least two months ago.

  • Booster doses of the Pfizer-BioNTech, Moderna, and Johnson & Johnson vaccines are all available immediately.

  • “If you’re 18 or older, go get boosted,” Dr. Anthony Fauci said last week.

Both the United States Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) on Friday authorized booster doses of all three COVID-19 vaccines for all Americans 18 and older—a major milestone in the fight against the pandemic.

This decision expands eligibility from older people, those with medical concerns, and essential workers to the vast majority of adults, just in time for the holiday season. After the agencies announced their decisions, booster shots of the two-dose, mRNA-based Pfizer-BioNTech and Moderna vaccines were made available immediately. (Both agencies previously recommended those who got the Johnson & Johnson vaccine two months after their initial shot.)

After a confusing few months of guidance on boosters, this new recommendation is much easier to follow: Just wait six months after your second dose of Pfizer or Moderna (or two months if you received Johnson & Johnson), then sign up for your booster. For now, only a single booster dose is recommended by the FDA; so-called “mix-and-match” boosters are allowed, meaning you can elect to get a COVID-19 vaccine booster shot different from the one you already received.

“COVID-19 vaccines have proven to be the best and highly effective defense against COVID-19,” said acting FDA commissioner Janet Woodcock, M.D., in a statement. “Authorizing the use of a single booster dose of either the Moderna or Pfizer-BioNTech COVID-19 vaccine for individuals 18 years of age and older helps to provide continued protection against COVID-19, including the serious consequences that can occur, such as hospitalization and death.”

Anthony Fauci, M.D., the nation’s leading infectious disease expert, put things more bluntly: “If you're 18 or older, go get boosted,” Dr. Fauci said on MSNBC on Thursday. “We are entering the winter season; the weather will be colder, people will be indoors, they’re circulating virus around. We’re seeing an uptick in some of the cases right now.”

So, are you eligible for a booster shot? Why are boosters necessary in the first place? And how can you sign up for your dose? Here’s everything you need to know about COVID-19 vaccine boosters, according to doctors.

How do booster shots for vaccines work?

“For some vaccines, after a while, immunity begins to wear off,” the CDC explains. “At that point, a ‘booster’ dose is needed to bring immunity levels back up.” Booster shots are extra doses of a vaccine administered sometime after an initial dosage has been received, re-upping your body’s immune response.

Some boosters are recommended very infrequently, like one for tetanus, which should be received every decade. Others (like the annual flu vaccine) are more frequent due to factors like changing pathogens and waning immunity. Different types of flu virus circulate each year, making an annual shot necessary to protect against the most dominant strains each flu season.

SARS-CoV-2, the virus that causes COVID-19, is also mutating, and the variant of most concern is currently Delta, which was first detected in India last December. So far, all of the available COVID-19 vaccines, especially the mRNA ones, appear to offer adequate protection from the Delta variant.

Is a COVID-19 vaccine booster shot necessary for full protection?

“At some point, most of us will need a booster,” says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine. “That happens with a lot of adult immunizations, including the flu vaccine.”

Although the available vaccines are highly safe and effective, their initial immunity is waning, leading experts to support boosters. Dr. Schaffner explains that the Biden administration has been “very impressed” with the booster shot data from Israel, and it’s easy to see why: A third dose appears to be highly effective in reducing severe COVID-19, hospitalization, and death, according to study after study.

“When you look at the data from Israel, it’s very clear that [a booster] reverses some of the waning effects that you see in people who have been vaccinated for six months or more,” Dr. Fauci said last week on the podcast The Daily. In fact, COVID-19 vaccine boosters “are going to be an absolutely essential component of our response. Not a bonus, not a luxury, but an absolutely essential part of the program.”

Booster shots can also address variants like Delta, explains infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security; for now, researchers and health authorities are relying on a third (or second if you received Johnson & Johnson) dose of the same vaccine formulation. In the future, however, vaccine manufacturers could tailor booster doses to new strains of the SARS-CoV-2 virus. “The COVID-19 vaccine may eventually become like the annual flu vaccine,” he says.

Why are boosters for Pfizer and Moderna necessary after six months?

Based on “the current state of the pandemic, the latest vaccine effectiveness data over time, and review of safety data from people who have already received a COVID-19 primary vaccine series and booster,” CDC director Rochelle Walensky, M.D., shared in a statement Friday, those extra doses are worth getting. They’re “an important public health tool to strengthen our defenses against the virus as we enter the winter holidays.”

“The available data make very clear that protection against SARS-CoV-2 infection begins to decrease over time following the initial doses of vaccination, and in association with the dominance of the Delta variant, we are starting to see evidence of reduced protection against mild and moderate disease,” officials from the United States Department of Health and Human Services (including Dr. Walensky, Dr. Woodcock, and Dr. Fauci) wrote in August.

“Based on our latest assessment, the current protection against severe disease, hospitalization, and death could diminish in the months ahead, especially among those who are at higher risk or were vaccinated during the earlier phases of the vaccination rollout,” the announcement continues. “For that reason, we conclude that a booster shot will be needed to maximize vaccine-induced protection and prolong its durability.”

For example, a small study of public health data from Israel released in late July estimated that the Pfizer shot was 39% effective at preventing people from COVID-19 infection in June and early July, compared with 95% from January to early April. (However, the vaccine was still more than 90% effective in preventing severe disease in people in June and July.)

“It is true that if you look at antibody levels produced by the vaccine, by eight months, they’re starting to wane,” Dr. Schaffner says. That’s why officials are recommending booster doses after six months—and why you should receive a COVID-19 vaccine in the first place.

Where can you register for a booster dose?

Because the CDC and the FDA both approve of booster shots, they’re now available just about everywhere—although it could take a few days for them to reach your pharmacy or doctor. After the initial rollout, there should be no shortage of available doses, since the White House has committed to producing 1 billion doses of the COVID-19 vaccines per year moving forward.

To sign up for a booster dose, first make sure at least six months have passed since your last dose of the Pfizer or Moderna vaccine (or two months since your Johnson & Johnson shot) and use the CDC’s site, contact your primary care provider, or visit your county’s public health website to find a vaccination site near you. Pharmacies like CVS, Walgreens, and Rite Aid also allow people to check availability and book appointments online.

Bottom line: Booster doses are now a reality.

“As we head into the holiday and winter season, now is the time to think about protection for ourselves and our families,” said Jeff Zientz, the White House’s COVID-⁠19 response coordinator, in a press briefing on November 17. “So many of us missed being with our friends and family last year. For those who are at higher risk of severe illness from COVID-19 and who are eligible for a COVID-19 booster dose, go out now and get your extra booster dose to protect you.”

“The vaccines are so important,” explains Abhijit Duggal, M.D., a critical care specialist at Cleveland Clinic. “We need to reach a point of as many people being vaccinated as possible, as quickly as possible. That’s the biggest thing we can do to get back to some degree of normalcy.”

This article is accurate as of press time. However, as the COVID-19 pandemic rapidly evolves and the scientific community’s understanding of the novel coronavirus develops, some of the information may have changed since it was last updated. While we aim to keep all of our stories up to date, please visit online resources provided by the CDC, WHO, and your local public health department to stay informed on the latest news. Always talk to your doctor for professional medical advice.

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