The debate over 2nd COVID boosters

“The 360” shows you diverse perspectives on the day’s top stories and debates.

What’s happening

The Food and Drug Administration has of the Pfizer and Moderna COVID-19 vaccines for people over 50 or with compromised immune systems.

The announcement, made late last month, came amid concerns that an even more transmissible version of the Omicron variant — known as BA.2 — , as it has in Europe and parts of Asia in recent weeks.

The second booster means a fourth shot for people who were initially vaccinated with the Pfizer or Moderna mRNA vaccines, or a third dose for those who started with the Johnson & Johnson vaccine. Despite an aggressive campaign by the Biden administration to promote boosters, and strong evidence that they provide a substantial increase in protection, uptake of the initial booster dose has lagged in the US Only about 45 percent of fully vaccinated Americans, according to the Centers for Disease Control and Prevention. Just under a quarter of the US population hasn’t been vaccinated at all.

At this stage in the pandemic, there’s that the vaccines dramatically reduce the risk of severe COVID infections and death, and an initial booster dose ramps up that protection even more. Evidence to support the use of a second booster is much more limited. A study out of Israel found that a fourth shot among people over 60, but there are questions about and how much second boosters help younger groups.

Why there’s debate

This lack of clear data has led to a disagreement among health experts over whether the FDA made the right decision in authorizing second booster shots for older Americans.

Supporters say that, while they won’t be the game-changer that the first doses have been, there’s reason to believe that second boosters will give extra protection to older people who face increasing risk as their immunity gradually declines over time. Others argue that it’s wise to err on the side of caution, given the unpredictability of the pandemic and the wide variance in the amount of risk that individual Americans face from the virus.

Critics of the decision say that although the fourth dose is just as safe as the first ones, there moving forward with second boosters does entail some risks. They argue that the extra protection another booster provides is minimal and could disappear in a matter of weeks. There are also concerns about “vaccine fatigue,” which could set in if health officials keep asking people to come back for more doses without strong evidence that they make a major difference.

What’s next

With an eye toward breaking the cycle of periodic surges whenever a new variant emerges, scientists are working to develop a that could protect against all forms of the virus and potentially provide more enduring immunity. While possible in theory, such a breakthrough is by researchers that could take years to become a reality.



It’s OK that there’s no clear answer right now

“I don’t think it is a right or wrong answer with a clear overwhelming evidence one way or another. That maybe makes it a bit confusing for everybody.” — Alessandro Sette, immunologist, to

Vulnerable Americans face greater risk every day as their protection wanes

“Too many people have waning antibodies, and there’s still a benefit to protecting against that new wave that may or may not come.” — Katelyn Jetelina, epidemiologist, to

There’s essentially no risk to getting an extra dose

“The upsides of a fourth shot are indeed uncertain: The best we can say right now is that its protective effects are probably modest and temporary (with greater benefits for older people). But a modest, temporary boost is still better than nothing—so why not go ahead and get one, just in case?” —Rachel Gutman

The pandemic has shown that it’s always better to have more protection

“Though it’s clear that the FDA is being tip-toe cautious, I love their decision. Let’s face it: Every time we have thought the coast was clear on Covid, we have been wrong. And every time we thought we were collectively immune enough from the virus — from prior disease or from the vaccines — we have been wrong.” —Kent Sepkowitz

The FDA was smart to make second boosters a matter of personal choice

“Those who are vaccinated and boosted might not opt ​​for an extra booster at this time, just as they could choose not to mask or regularly test. … For the elderly and for the medically frail who would end up in the hospital with any respiratory infection, I understand the rationale for choosing the additional shot. They want to do everything they possibly can to avoid contracting covid-19.” —Leana Wen


We need better vaccines, not more doses of the same ones we already have

“It’s become clear that our current vaccines won’t end the pandemic. But that’s no reason to give up hope; a vaccination campaign with better vaccines still might.” —Faye Flam

Second boosters only appear to make a small difference

“A fourth mRNA vaccine dose for the average, healthy American might reduce the incidence of mild infections for a few weeks to months, but it would have minimal additional impact on preventing serious disease and death.” — John P. Moore and Luciana L. Borio,

The goal should be to prevent severe infections and deaths, initial doses already do that

“Vaccine-induced protection against infection is short-lived and doesn’t get much of a boost from extra shots. Yet the initial two-dose regimen is enough to provide most patients excellent protection against severe disease.” —Philip Krause and Luciana Borio,

It doesn’t make sense to give people boosters when cases are relatively low

“The COVID vaccines are safe and effective and have undoubtedly saved millions of lives so far. I believe that boosters are important, and will continue to help save lives — but the timing matters.” — Eddy Bresnitz

The debate over boosters is irrelevant with so many people still unvaccinated

“The most important thing that we as individuals can do right now is, No. 1, to vaccinate the unvaccinated. There are so many people who have not started their series for whatever reason. … The solution to this pandemic is to get as many people vaccinated as possible. It’s still the solution to getting us to the other side.” — Sabrina Assoumou, infectious disease expert, to

Vaccine fatigue is a real concern

“What’s the risk of frequent boosting? There don’t seem to be immunological/health risks & opportunity costs. But there are psychological risks (eg, vaccine fatigue & skepticism). We should ask Americans to roll up their sleeves when it matters most.” — Celine Gounder,

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Photo illustration: Yahoo News; Photos: Justin Sullivan/Getty Images

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