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Those eligible for the shot will include anyone 65 and older and those who are immunocompromised. People who are immunocompromised can opt for more frequent shots if recommended by their physicians.
Many Checkup readers have been eagerly awaiting this decision. Some have already taken matters into their own hands, even before second boosters were officially allowed.
Jane from New York, a cancer patient in her 80s, wrote that she wants to go to a pharmacy this weekend to get her second booster shot. I think this is reasonable. Those who have been trying to get the additional booster and are now eligible should go get it.
New data presented at this week’s CDC meeting shows that protection against emergency department visits for those 65 and older waned from 61 percent in the first 60 days after the first bivalent booster to just 25 percent by four to six months. Protection against hospitalizations also dropped from 64 percent to 39 percent.
Jane and others who want the second shot right away should call their local pharmacy and make sure they are administering it. It often takes a few days for facilities to change their procedures after federal guidance is issued.
There are some people who aren’t convinced that they need this shot. Michael from Virginia received his first bivalent booster dose in February. He wrote that he is in the minority among his friends, all in their mid-to-late 60s, who received even that shot.
“I’m pretty healthy; I run three times a week. I’m not worried about covid,” he wrote. “I figure I can wait until the fall when a new vaccine comes out. If I get covid in the meantime, I’ll take Paxlovid.”
Michael is probably right that he is unlikely to become severely ill from covid, especially if he takes Paxlovid soon after diagnosis. He also received this first bivalent booster shot a couple of months ago and wouldn’t be eligible to receive the second one now, anyway. (The updated guidance is that individuals 65 and older can receive their second booster shot four months after their first; immunocompromised people can receive it after two months.)
On the other hand, I think Michael’s similarly aged friends need to get their first bivalent booster shot for their own protection. As I wrote before, public health efforts should focus on getting higher-risk people their first bivalent shot; it’s a major problem that more than half of people 65 and older have yet to receive it.
“Is there a downside to getting more and more boosters?” Amy from Nevada asked. With every vaccine, there are expected side effects, such as fever, body aches and pain at the injection site. There is also a theoretical possibility of a phenomenon known as “immune imprinting,” in which overly frequent vaccination could impede the body’s response to new pathogens.
There is evidence for and against this hypothesis. That said, the possibility of imprinting is one reason young, healthy people do not need this second bivalent shot. For them, unlike more vulnerable people, the benefits are minimal, and there is potential for risk.
It’s also why I wouldn’t advise someone who had a recent covid infection to receive the second bivalent booster shot. They are probably still well protected against both reinfection and severe illness, and they could wait until the fall to receive another shot.
What about people who aren’t in high-risk categories themselves but are around those who are? Nimmi from Connecticut wrote that she is in her mid-50s and cares for “very elderly, vulnerable parents.” She asked, “Am I eligible to get the second bivalent booster, and if so, would you advise it?”
My answer to both is no. The primary benefit of the coronavirus vaccines is to reduce the likelihood of severe illness. They are not as effective in reducing infection and therefore transmission to others, and this modest effectiveness wanes quickly.
Nimmi’s parents are eligible to receive their second booster shots and should do so immediately (after consultation with their physician to make sure it is advised, of course). But she is not eligible, and I would not advise that she look to get it to protect her parents. Instead, she should continue to take precautions to avoid infection, including masking in crowded places and taking coronavirus tests after known exposures.
The bottom line is that the bivalent booster is a good tool now available to higher-risk people in the United States. Newly eligible individuals who remain concerned about contracting the coronavirus should consider getting it while making sure to also use other protective mechanisms and to have a treatment plan in the case of infection.
What questions do you have about getting the second bivalent booster shot? I look forward to answering them!
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