FDA authorizes another COVID booster shot but experts say some people probably can safely wait

Federal regulators said this week they would allow a second booster dose of the COVID-19 vaccine for older people and those with medical conditions, leaving the public to decide if and when to get another shot.

Even though boosters were recommended, there hasn’t been huge uptake nationally since the first boosters were authorized last fall. That’s a third shot after two Pfizer-BioNTech or Modera doses and a second shot after one dose of the Johnson & Johnson vaccine for those 12 and older.


In Maryland, despite a heavy push, the public hasn’t chosen an extra shot much more often. Of the overall population, about 37% is boosted in Maryland compared with about 30% of the country.

Demand for another dose is likely even lower, and experts say most people can probably safely wait if they are fully vaccinated, including an initial booster, because they are probably still fairly well protected against severe disease. Plus the rate of infection is low in Maryland at the moment.


“I don’t think there is a huge downside to getting a booster dose now for the most at-risk people,” said Dr. William Moss, executive director of the Johns Hopkins International Vaccine Access Center.

“But there may be another push or opportunity for second booster doses in the fall for everyone else,” he said, “particularly if we anticipate a late fall or winter surge in cases if SARS-CoV-2 behaves like a more typical winter respiratory disease like influenza, though there is no guarantee that’s what happens.”

By authorizing another booster, U.S. Food and Drug Administration officials said they wanted certain people to have the option, recognizing immunity that develops after vaccination or infection wanes.

They specifically are allowing another booster 4 months after the last booster shot of any vaccine specifically for those at least age 50 or immunocompromised. They don’t develop and maintain protective antibodies as well and are at higher risk for hospitalization and death, and studies increasingly show the boosters bump up protections.

“Current evidence suggests some waning of protection over time against serious outcomes from COVID-19 in older and immunocompromised individuals,” said Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, in announcing the change Tuesday.

“Based on an analysis of emerging data, a second booster dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccine could help increase protection levels for these higher-risk individuals,” he said. “Additionally, the data show that an initial booster dose is critical in helping to protect all adults from the potentially severe outcomes of COVID-19. So, those who have not received their initial booster dose are strongly encouraged to do so.”

In supporting the FDA’s move, the U.S. Centers for Disease Control and Prevention said that during the recent omicron surge those boosted were 21 times less likely to die from COVID-19 compared to the unvaccinated. Those boosted were also seven times less likely to be hospitalized.

Maryland Gov. Larry Hogan, a cancer survivor, has joined public health experts in repeatedly urging those eligible to get vaccinated and boosted. Hogan was boosted before testing positive for COVID-19 in December but credited the vaccinations and monoclonal antibody therapy for stopping his “cold-like symptoms” from worsening.


Normally, people can be boosted after their isolation period ends, but the CDC recommends waiting 90 days after receiving monoclonal antibodies for the extra shot.

Moss said infections also serve as something of a booster by driving up levels of antibodies, which defend the body from infections. Though Moss said individuals might want to check with their medical provider on their specific risk.

He and others say those who are elderly and medically fragile should consider a booster now. The FDA wasn’t more specific in its authorization and took the unusual step of not seeking input from its advisory panel, which Moss said likely would have produced lively debate and more specific advice on who would be most likely to benefit and when.

Namandjé N. Bumpus, a professor and director in the department of pharmacology and molecular sciences at Johns Hopkins School of Medicine, agreed that anyone eligible should have a booster shot now and anyone at high risk from COVID-19 also should go ahead and get the second booster.

She said people who were infected during the winter wave linked largely to the initial omicron variant, called BA.1, shouldn’t assume they are fully protected from the new omicron subvariant, BA.2, now dominant across the country. It takes lab testing to know which variant a person caught.

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Bumpus said people can mix the vaccines and get a Pfizer or Moderna booster if that’s what’s available. Moderna boosters are lower doses than the initial two-dose regimen but Pfizer is the same dosage.


“It’s important for everyone to get the initial booster if they are eligible,” she said.

“We see a marked increase in protection against severe COVID,” she said. “For folks who have an underlying condition or are immunocompromised, an additional booster is something to think about. A lot comes down to individual health conditions and also who you are around, if you think you could be potentially exposed.”

In Maryland, health officials and Hogan continue to support boosters, launching a second statewide cash lottery in February for anyone who got the shot as an incentive.

The state continues to run testing and vaccination venues around Maryland, and health officials said they are maintaining other sites on “warm” status, able to ramp up quickly if there were to be another surge.

State health officials say they will continue to monitor BA.2, considered even more contagious than BA.1. The state continues to test samples of positive cases in the state and is finding an increasing number are BA.2.

“We continue to encourage all Marylanders to get tested, vaccinated, and boosted as the best lines of defense against COVID-19,” said Andy Owen, a state health department spokesman. “Our GoVAX Maryland campaign remains active, with a significant presence on statewide mass- and social-media channels.”