Opinion | The Checkup With Dr. Wen: What to consider when choosing to get a second booster shot

Unlike prior guidance, in which the Centers for Disease Control and Prevention explicitly recommended that newly eligible people should receive the vaccine, the new change says they may choose this booster if they wish.

I think earlier CDC guidance could have been framed as a permissive recommendation, too, especially regarding boosters for children and healthy young people. Indeed, the American public has understood it as such; the CDC’s own data shows that only about 17 percent of people eligible to receive a first bivalent booster have done so.

Some readers have already sought the second booster under the new guidelines, though not all have been successful. Maureen from Texas wrote that her husband, who is 72 and has heart failure and asthma, made an appointment at their local pharmacy. “When he got there, they refused to give him a shot. I’m confused — it’s been seven months since his bivalent booster. Is he or is he not eligible for another bivalent booster?”

He is eligible, and Maureen should try again. Consider calling a couple of other pharmacies in the area to make sure that they understand the CDC guidance has changed: Your husband and others older than 65 can receive a second bivalent booster four months after the first.

People who are moderately or severely immunocompromised can receive a second bivalent booster two months after the first. But should they? Melissa from Georgia wanted to know whether her 13-year-old, who is taking an immunosuppressive medication for Crohn’s disease, should get a booster now. Sam from Orgeon is 42 and just received a bone-marrow transplant and asks, “When is the optimal time to get my second booster?”

I would advise Melissa and Sam to contact the physician most closely tracking their health. Their health-care providers need to help them weigh multiple factors, including their risks from covid, degree of immunosuppression, prior responses to the vaccine, and medication regimen. The revised CDC guidance gives physicians treating immunocompromised patients leeway to tailor a vaccine schedule for their specific medical situations.

Many readers have asked whether they should wait to get the booster. The most common reason seems to be fear that if they got a bivalent shot now, they won’t be able to receive another one in the fall.

“I am 83, have well-controlled diabetes and a heart valve issue, but I am in good health otherwise and, in fact, still work full-time,” wrote Larry from Michigan. “I received a bivalent booster at the end of last September. Should I get a new booster now or wait until the fall for the new booster?”

Ethel from D.C. has a nearly identical situation, and adds, “I really want a spring booster, but not if I can’t get the vaccine that’s updated against new variants in the fall. Will there be a more updated vaccine then, and can I receive it if I get the second bivalent shot now?”

The FDA and CDC have said they will consider an updated formulation of the coronavirus vaccines in June. We don’t yet know what that formulation will be; presumably, it will more closely target circulating variants. But no matter the exact formulation, there will be a push for the coronavirus vaccines in the fall, with the timing to coincide with the annual flu vaccine.

Those eligible for the second bivalent boosters now are the most vulnerable to severe outcomes from covid, and I cannot imagine a situation in which they won’t be able to get another shot in the fall. In fact, I’d bet that this is the group prioritized to receive those fall vaccines.

People should not put off their spring boosters if the concern is that it could somehow hamper their ability to get another coronavirus vaccine in the fall. Larry and Ethel, with their ages and medical conditions, should consider getting an updated booster now, in consultation with their physicians. Since the current recommendation states that those older than 65 must wait at least four months between shots, they’d be eligible to be vaccinated again by early September.

What about people who are neither immunocompromised nor old enough for another booster? William from Georgia says he will be 60 this summer and has diabetes and high blood pressure. “I have never had covid and am making it a high priority to avoid getting it. I very much would like to get an additional booster now but don’t fall into any of the categories allowed by the CDC. Would you suggest I try to get one anyway?”

I would not. As I discussed before, the effectiveness of boosting to reduce infection is modest and short-lived. People who prioritize avoiding covid should continue mitigation measures, including masking in crowded indoor places and dining and socializing outdoors.

“Is there a benefit to getting the Pfizer booster if I got all Moderna before?” Deborah from Wisconsin asks. There is no clear evidence either way. “Mix-and-match” is permitted, and people are able to receive either the Pfizer or Moderna bivalent booster no matter which version they received for the first.

I know many readers have a lot more questions. The Post has scheduled a Live Q&A session next Friday, May 12, at noon Eastern time. Please submit your queries. I’ll answer them next week!