What you should know about COVID-19 booster shots and third vaccine doses

Assoc. Prof. Emily Landon answers common questions about additional vaccine doses

Increasingly, research shows many people who have weakened immune systems haven’t been able to receive full protection from their COVID-19 vaccines. Unlike healthy people who’ve been vaccinated against SARS-CoV-2, the virus that causes COVID-19, immunocompromised people’s bodies may not produce enough protective antibodies after two doses of the COVID-19 vaccines. This could leave them particularly vulnerable to COVID-19, especially as more contagious variants circulate in a community. 

That’s why federal health authorities announced in mid-August that they would allow immunocompromised people to get special, additional doses of the Moderna and Pfizer/BioNTech vaccines. This week, U.S. officials also announced that they will prepare to offer booster shots starting the week of Sept. 20 for healthy, immunized people. The boosters will be available to individuals eight months after the completion of their second dose.

In the following Q&A, Assoc. Prof. Emily Landon explains what you should know about additional COVID-19 vaccine doses. An infectious diseases specialist and hospital epidemiologist, Landon is the executive medical director for infection prevention and control at UChicago Medicine and is one of Chicago's preeminent experts on the coronavirus.

Am I eligible for a third dose of the COVID-19 vaccine?

In the United States, only people with weakened immune systems are currently eligible for a third dose of the COVID-19 vaccine. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) says these doses for now should go to only those who are immunocompromised and who received the mRNA vaccines made by Pfizer or Moderna.

While that is expected to change later this year, this group currently includes patients who’ve had or are receiving: 

  • Organ transplants 
  • Stem cell transplants within the past two years
  • Active cancer treatment for tumors or blood cancer and are undergoing chemotherapy that affects the immune system
  • Severe primary immunodeficiency
  • Advanced or untreated HIV
  • Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response.

There is not enough data yet to know whether immunocompromised people who got the one-dose Johnson & Johnson vaccine need another dose, but we expect to know more soon. 

You are not eligible for a third dose of the vaccine at this time if you are healthy, do not have one of these specific conditions, or do not take certain immunosuppressive medications. However, if you received a Moderna or Pfizer vaccine, you will be eligible for a booster shot eight months after your second dose.

Is a third dose the same thing as a booster dose?

The dosages are the same, but there’s a small medical distinction. The term is used differently based on who is receiving it. Boosters are offered to people who got the full course of a vaccine and developed a good response initially, but it waned over time. Third doses are given to people whose immune systems weren’t able to fully respond to the initial vaccines. That’s why the FDA and CDC first recommended an additional dose for immunocompromised individuals.

In the U.S., federal health officials say they expect boosters to begin the week of Sept. 20. Healthy people who got the Moderna or Pfizer vaccines will be eligible to receive a booster eight months after their second dose.

Does my booster vaccine need to be the same brand as my initial vaccine? 

If possible, yes. The CDC recommends that booster doses match the original mRNA vaccines people received earlier this year. This subsequent dose should be given at least 28 days after the second dose of the vaccine. If you absolutely cannot find a matching dose of vaccine, it would be OK to get the other one. 

If I am immunocompromised, will I be fully protected after I get my third dose of the vaccine?

No. If you are immunocompromised, a third dose is supposed to provide you with better protection from COVID-19, but it may not provide you with the same level of immunity as healthy people. In studies, most participants who had any immune response to the first two doses did better after a third dose, but some people didn’t. If you’re immunocompromised, that means you should still take extra precautions to avoid getting COVID-19, such as wearing a mask (especially inside) and avoiding large crowds or high-risk activities. Consider wearing eye protection (like a face shield), particularly if you’re around unmasked people who may be unvaccinated. 

Discuss your ongoing risk with your healthcare provider and ask them how you should reduce your risk. It’s important that your family members and regular close contacts get vaccinated, too. This decreases the likelihood that you will be exposed to COVID-19. 

I have a health condition that isn’t on the CDC’s third-dose list. Can I still get my COVID-19 booster shot?

If your health condition is not on the CDC’s third-dose list, then you are not yet eligible for an additional shot. If you aren’t sure whether your condition counts, contact your doctor. Hospitals, doctors’ offices and pharmacies can give third doses only to people who federal public health authorities have said should receive the additional doses. Other people will be able to get booster shots as early as this fall. Federal health officials say people shouldn't get boosters until eight months after their second dose.

Why didn’t we know booster doses would be needed before? 

We’re still learning about the COVID-19 vaccines and how well—and for how long—they protect us from the virus and its emerging variants. The CDC’s decision to provide third doses to immunocompromised people was made after data showed these groups were particularly vulnerable to infections since they had little protection from their earlier immunizations. We will keep learning about these vaccines in the coming months and years, which means we will adjust our vaccine plan accordingly. 

Will more people eventually need additional doses of the COVID-19 vaccines?

It’s almost certain that most people will eventually need to get booster shots or additional doses of the vaccines. However, we are still studying how long the vaccines will protect people. The good news is that people who are healthy should still have ample protection from their COVID-19 vaccines. While some healthy, vaccinated people do get COVID-19 infections, they are much less common than in unvaccinated people and they are much less severe. This is why it’s important for people who haven’t received their vaccine yet to get it right away.

—Adapted from a story first published by UChicago Medicine.