COVID-19 Booster Basics: What You Need to Know Now


Booster shots are here for some, on the horizon for others and a relief for all.

Right now the focus is on the most vulnerable population, meaning those who are immunocompromised, so they are eligible to get their third doses now.

Clarifying the latest information from the CDC and FDA is Binita Patel, PharmD, MS, vice president of Pharmacy Services at Memorial Hermann Health System.

Q: Who is considered moderately to severely immunocompromised?
A: This group of people includes about 3 percent of the population, including those who:

Are being treated for tumors or blood cancers.
Are undergoing chemotherapy or taking antimetabolites or alkylating agents for cancer.
Have an untreated or advanced HIV (Human Immunodeficiency Virus).
Have had stem cell or Car-T-cell transplants within the past 2 years and are on immune-depressing medicine.
Have kidney, lung or other solid-organ transplants.
Have a moderate to severe immunodeficiency due to rare syndromes such as DiGeorge and Wiskott-Aldrich.
Q. Are "third doses" and "boosters" the same thing?
A: No, they are not.

“Boosters” are for healthier people and are given because the immune response to the original vaccine series from Pfizer-BioNTech or Moderna starts to weaken over time.

People with moderate to severe immunodeficiencies are offered “third doses” due to their weak response to initial inoculations against SARS-CoV-2. They can get their third shot a month after their previous one and may need more shots in the future.

“Those who are in poor health should get their third shot and not wait. They can get it right now,” Dr. Patel says.

Third doses should be mRNA COVID-19 vaccines, which are from Pfizer-BioNTech or Moderna. The FDA has yet to approve a new round of Johnson & Johnson’s vaccine because clinical trials focused on the one-and-done approach.

Q: When will boosters start?
A: The CDC and FDA are looking into when others will need boosters and will give healthcare providers and the public recommendations on the timing for booster shots soon. Memorial Hermann will be ready to help you obtain your booster shot when it's time. You can go to the to learn more.

Q. Who will be eligible for a booster? When will it open up to everyone?
A: It will likely be front line will be healthcare workers and those with naturally lower immunity, nursing home residents and “older people,” who are over 65 similar to last time. Memorial Hermann will follow the guidance of CDC of eligibility and when they recommend opening up to all patients.

“Those were the people who were immunized earliest since they were at the highest risk of COVID-19,” Dr. Patel says. “The panel wants to prevent severe disease.”

Q. Why should I get a booster since I’m already “fully” vaccinated?
A: “Boosters offer continued immunity for those of us who already are vaccinated,” Dr. Patel says. “Studies have shown that after eight months, immunity starts to decline. Boosters will help us fight delta and other novel variants. They will protect us and our families from getting COVID-19 and spreading it to those who are not vaccinated.”

Q. Why has the guidance on boosters recently changed?
A: Not only have we seen that immunity is weaker, but also, we want to protect people from new and future variants. SARS-CoV-2 is a wily virus that continues to mutate, as viruses do. Already on the horizon are the lambda variant out of South America and the mu variant out of South Africa.

“The current thought is we’ll have a booster annually against emerging variants,” Dr. Patel says.

Q. Should my booster be the same vaccine as my previous shots?
A: “The recommendation is to stay with the same vaccine,” Dr. Patel says, “but if you cannot get a shot from that manufacturer, it’s OK to substitute. We don’t have a shortage of vaccine supplies, so most likely you can get the one you got previously.”

Q. Is the booster a different formula than the first and second doses?
A: No. It will be the same dose as the first two doses, and it will be available to the same ages, 16 and up.

Q. Will a COVID-19 booster be needed annually?
A: It’s difficult to say at this point considering the vaccine has only been available for several months. Long-term data on immunogenicity will be needed to determine whether annual boosters will be needed.

“The current thought is we’ll have a booster annually against emerging variants,” Dr. Patel says.

Q. What are the side effects of boosters?
A: So far, reactions reported after the third mRNA dose were like that of the two-dose series. You can expect to have the same experience as with your earlier shots. Fatigue and pain at the injection site were the most commonly reported side effects, and overall, most symptoms were mild to moderate.

Q. Is proof of receiving the booster added to your vaccine card?
A: Yes. Documentation of vaccination would be managed in the same manner as the first two doses. Current CDC COVID-19 Vaccination Record Cards have additional space for vaccines.

For more information about COVID-19 vaccines, click here.

The information in this article is accurate as of September 8, 2021.

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