5 questions with an expert: Who needs a covid booster?

Now that the Food and Drug Administration has authorized a second covid-19 booster for Americans age 50 and older, many people are probably wondering how to proceed.

The Tribune-Review posed five questions to Pittsburgh-based infectious disease expert Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

Question: Is a fourth covid shot for people 50 and over necessary, in your opinion?

Answer: Not as a universal recommendation, but there are segments of the population for which it is indicated. The better question is who benefits from a fourth dose of the covid vaccine?

Q: So, who should get it?

A: In my analysis the immunocompromised population, which has been eligible to get a fourth dose since October, should be the ones prioritized for fourth doses. Outside of that, there’s not much data to show a strong benefit, but there are likely some other high risk individuals – the extremely elderly, people with high risk conditions – that may benefit. But the benefit is going to be marginal on top of the third dose.

Q: Should people over age 50 seeking another Pfizer or Moderna dose wait until after the summer/beginning of fall since cases go down so much in the summer months?

A: If you are an immunocompromised person, you should be up to date now. (A third dose for immunocompromised people was approved by the CDC in Aug. 2021 and a fourth dose on October 27, 2021 – months before they were approved for the general population). There may be differences in case numbers (between summer and fall), but if you are an immunocompromised person you should have optimal protection all the time. There’s a debate over who actually needs (a booster) that’s going on in the medical community. The immunocompromised population needs fourth shots – people with moderate to severe immunosuppression, people who are on high doses of steroids, who have had a transplant, who are on chemotherapy, people with advanced AIDS – those are the people where I think the fourth dose actually has a benefit. And that’s the case if you’re 48-years-old. If you are a 48-year-old liver transplant patient, you should get a fourth dose. I think the vast majority of people don’t realize that immunocompromised people were authorized for a fourth dose in October. (Tuesday) they authorized fifth doses for immunocompromised people.

Q: Is there a difference between what is in Pfizer’s fourth shot and Moderna’s?

A: They have slightly different ingredients and the dosages are different, but the dosages have been different all the way through with Pfizer and Moderna.

Q: The Biden administration said it has set a goal of preventing severe disease caused by covid-19, and it’s not focusing as much on the total case numbers. What are your thoughts about that approach?

A: That’s the approach I’ve advocated from the very beginning. This is an approach that reflects what you do with a respiratory virus that is destined for endemicity and cannot be eradicated. You shift the disease spectrum to the mild side. This is a long-overdue shift in our strategy because the hospital capacity has always been what’s most important and when you have the tools like vaccines and antivirals, you’re in a different position where cases don’t have the same meaning as they once did because they’re increasingly being decoupled from severe disease. A better gauge of where you are in the pandemic is to look at hospitalizations and severe disease – because that’s always been the goal of what we’re trying to prevent.