Second Booster Shots: Who Should Get One and When?

Del Rio adds that younger, healthier individuals in the eligible population can get the second booster if they want to, “but for the time being, it’s not going to help you that much.” While some protection afforded by the vaccines wanes, the primary series and first booster “continue to hold incredibly well against severe disease and death” in these less vulnerable populations, he says.

Another factor to consider when weighing your risk: recent infection. Like millions of Americans, Moss — who is 64, boosted and “otherwise healthy” — had COVID-19 during the winter omicron surge. “In some ways, that infection is a booster dose to your immune system,” he says. So right now, he doesn’t feel “an urgency to get a second booster dose.”

What’s happening in your community?

Reported cases of COVID-19 have largely leveled off and are approaching pandemic lows, which means risk of exposure has also decreased in many areas of the country, Moss points out. But we all know that could change. Several countries in Europe just experienced a surge in cases fueled by the omicron BA.2 subvariant, which recently became the dominant strain of the coronavirus in the U.S. Experts say BA.2 could cause a bump in cases here — some areas are already seeing an uptick — but they are not anticipating a wave as cataclysmic as the one caused by omicron.

If numbers start to tick up again, “then that kind of changes the calculus,” Moss says. His advice: Keep an eye on what’s happening in your community. (You can track community transmission rates on the CDC’s website and find guidance for your area.) If transmission levels start shooting up and you haven’t had the second booster, “then that may make the decision to get the second booster earlier rather than later,” Moss says.

This advice holds true for travel destinations, too. If your spring or summer plans include trips to cities or countries battling high levels of the virus, aim to have your second booster several weeks before departure to ensure your antibody levels are at their highest. Antibodies are proteins produced by the immune system that help to fight off an infection and keep you from getting sick.

“You don’t want to time it too close to your travel or you won’t have realized that full benefit,” Drews says. “But again, if you’re in that high-risk population — if you’re 65 or older, or you’re a transplant recipient, or you have diabetes — I would go ahead to get it now. I wouldn’t wait.”

And while you’re examining transmission trends in your area, think too about your access to testing and treatments, which can influence the outcomes of an infection. Thousands of pharmacies and clinics throughout the U.S. can test people who think they might have COVID-19 and, for positive patients, prescribe treatments on the spot. You can find if one of these so-called test-to-treat locations is near you on COVID.gov.

In addition to the vaccines, “we need to be able to use other tools in our toolbox,” Moss says.

Are there any downsides?  

There aren’t any known downsides to getting another booster, even if you don’t need one, experts say. The vaccines have a solid safety record, and serious side effects are rare.

The risk of myocarditis — one of these uncommon side effects — in the 50-plus age range “is really considered to be minimal,” the FDA’s Marks said. “The side effect profile that was looked at in a million individuals who had received additional doses in Israel looks very favorable in this age range.” That said, you should plan for some possible, albeit temporary, side effects after the shot. Fatigue, fever, headache, muscle pain, chills and nausea are all common symptoms reported after the COVID-19 vaccines and other vaccines.

But there also don’t seem to be any benefits to an added boost for people who don’t need one — again, we’re talking about younger individuals who don’t have any health issues — especially when it comes to building the longer-lasting cellular immunity that helps to protect the body from severe disease.

“Individuals will always get an increase in their antibody levels after a booster dose. But how critical that is isn’t clear,” Moss says. “It comes back to: What is really our goal with vaccinations? Is our goal to just try to prevent all infections, which is almost an impossible goal for a vaccine, or is it to prevent severe disease and hospitalizations and death, which is a much more reasonable goal? And I think we’ve probably reached that in most individuals with three doses.”

The FDA has a meeting April 6 to discuss the future of boosters, including whether more will be needed for a broader swath of the population and how often. Health officials will also discuss what those vaccines might look like. It may be that in the next several months to a year, we have more options for boosters, Moss says, like variant-specific vaccines or nasal vaccines that provide local immunity. Scientists are also working on developing a vaccine that could work against multiple coronaviruses. 

It’s also possible, “particularly in otherwise healthy, younger adults, that they may not need an annual booster,” Moss says, though this depends on the course of the pandemic and any variants that may emerge. “Maybe that annual booster is more for the most vulnerable.”

What’s the takeaway?

The key message is to evaluate your risks, and if you have any questions, talk to your doctor.

“Again, the major determinants are age and then your underlying health conditions,” Drews says. “And the more your personal risk is of severe COVID, then the sooner you want to go ahead and get that second booster.”

And don’t forget about other tools that can help to prevent severe illness: High-quality masks can help keep an infection from happening in the first place, and if you do get COVID-19, a menu of treatments can help to prevent the disease from progressing.

“I think the other thing that’s important is, if you haven’t been vaccinated or boosted, you should. Because I’m more concerned about the millions still who have not been vaccinated, or the millions over 65 who have yet to receive their first boost. That, to me, should be a focus,” del Rio says.