Advice from my primary care doc: Should you get a booster? If so, which one?

October 25, 2021 • 10:45 am

If you’re contemplating getting a booster shot, as I did (the Pfizer), you should read this blog post by Dr. Alex Lickerman, my primary care doc who has, as you may know, written a whole series on Covid-19 for the layperson.  This is post #16.  Click on the screenshot below to read his booster take and see links to the other posts.  NOTE: Alex has kindly agreed, as he often does, to answer readers’ questions about Covid, so fire away in the comments section below.

Here’s the intro, the short take, and then below I’ll list the topics he takes up:

In this post, we explore the pros and cons of getting a third booster shot (or second booster shot if you got the J&J vaccine) against COVID-19. As usual, if you’re less interested in how we got to our conclusions than you are in the conclusions themselves, feel free to skip to the BOTTOM LINE in each section and the CONCLUSION at the end.

Question: Should you get a third booster shot?

Answer: It depends on how likely you are to have a bad outcome if you contract COVID-19 as well as your specific goals in getting vaccinated.

The topics of the post:

ESTIMATES OF CONTINUING VACCINE EFFECTIVENESS

WHAT DOES WANING EFFECTIVENESS MEAN IN THE REAL WORLD?

BENEFITS OF A THIRD SHOT

RISKS OF A THIRD SHOT

WHAT THIRD SHOT SHOULD YOU GET?

I got my booster because I’m older and thereby in the ‘at risk’ group, but I’m also going to Antarctica on a ship for a month in March, and wanted the extra protection.  Note: Alex also recommends in his post which of the possible boosters will boost you the most. But you’ll have to see that for yourself.

34 thoughts on “Advice from my primary care doc: Should you get a booster? If so, which one?

  1. Thanks – Dr Lickerman is very informative, as always. I actually booked booster shots for my parents this morning. The policy in the UK is to mix and match, so it is reassuring to see his views on this aspect.

  2. I am a great fan and appreciator of your column Dr. Lickerman. I received two Moderna vaccinations and am scheduled for a booster in a few days. I suspect it will not be Moderna but…. I don’t want to take a chance and wait if it isn’t Moderna. I think you’ve answered my question but perhaps I should hear it one more time: Do it.

    Thanks.

    PS–I am on your mailing list and could have used that to ask my question but Professor Coyne has made this convenient. I’ve only scanned today’s mailing from you but will read it later.

  3. Very nice post, thank you PCC(E) & Dr. Lickerman! I got the J&J initially, and after fretting about dying for a bit I’ve been most pleased with the protection it provided. At more than one point I know I have been exposed, and unvaccinated folks at the same exposure event did get Covid and I did not. Hurrah for science! I think I’ll see if I can get myself a Moderna.

  4. Hi Dr. Lickerman, Thanks for answering our questions. We are both over 70 and have had our booster shots, and we don’t have complicating health conditions.
    Question: In general, the vaccine seems to reduce chances of serious illness or death by a factor of about 10. In our circumstances, what are the chances of serious illness or getting long-term auto immune problems from Covid if we get infected? Frankly, the long term problems worry me the most, since unvaccinated people seem to get these with rather mild cases of Covid infection, and vaccinated people commonly still get these sorts of mild cases of Covid.
    Thanks for your advice, Charles Sawicki

    1. Hi, Charles,
      The risk of long COVID is estimated to be between 20-30%. Not low! Preliminary data suggest the first round of immunizations without the booster will reduce that by 50%, down to 10-15%. We have no data on how a third shot will affect that risk.

  5. I plan on getting the booster (Pfizer) as that was what I had for the regular shots before. I was not able to get them before getting Covid about a year ago. I figure with having had it and then the vaccines i should still get the booster. Not something I want to get again.

  6. I am in my mid-40’s, work in an elementary school in a medium-sized city and had gotten Pfizer’s vaccine in January and February. I had planned on getting a booster since the majority of our students are too young to get it and our entire district seems to have a disturbingly large number of anti-vaxxers, including close colleagues. I have as of yet thought of any reason why I should not get a booster, especially since those who haven’t gotten any shots yet probably aren’t going to, ever. Jesus and/or Kendi will protect them, apparently. Any additional advice?

    1. The reasons not to get a booster would be because: 1) you had a natural infection on top of immunization (you’re likely still highly immune), 2) you want to avoid unpleasant immediate side effects, or 3) because you had a serious complication (myocarditis, blood clot). Barring those three scenarios, there really isn’t much reason not to.

  7. Thanks for this important information. I got my Pfizer booster a couple weeks ago. No side effects again…maybe a bit tired, but no biggie. It will be interesting to see what the advice is in another 6 months. I suspect, like the flu shot, it will be a yearly (or biyearly?) recommendation.

    My parents, in their mid-70’s, are anti-vax and got Covid last year before Christmas. They’ll be here this Christmas, and I hope the rest of us vaccinated people don’t infect them. They “don’t like being told what to do”. And their primary care doctor (in Wyoming) said since they already caught Covid, they don’t need the shot. I suspect that doctor doesn’t know what he’s talking about. It’s beyond frustrating. Strange how so many Americans (even smart Americans) are really stupid when it comes to this vaccine.

    1. Actually, the degree of immunity from natural infection is high. Some studies suggest higher than from immunization, while others suggest lower. I’d still get them vaccinated, but not getting vaccinated after you’ve been infected is not an entirely unreasonable stance.

      1. I still cannot understand why there is not yet an affordable and rapid test for anti-covid neutralizing antibody levels. I suspect and have increasingly heard that many who are reluctant to get the jabs justify that decision on the basis of their belief that prior infection has conferred a robust and lasting immune response, so why go to the hassle? Hell, as a 2x vaxxed Moderna recipient, I’d like to know where on the dial my existing immunity lies. Clearly we have the means to answer those questions (else why would we know about waning immunity levels), why on earth is there not a simple test of extant levels of immunity???

  8. My parents, in their mid-70’s, are anti-vax and got Covid last year before Christmas. They’ll be here this Christmas, and I hope the rest of us vaccinated people don’t infect them. They “don’t like being told what to do”. And their primary care doctor (in Wyoming) said since they already caught Covid, they don’t need the shot.

    Sigh, same here, Mark. Except when my mom got it, my dad didn’t, which bolstered him belief that it was no big deal. He then sent me an article written by an alleged doctor filled with the worst misinformation. I looked up the doctor because I was aghast this article could have come from an actual medical professional. Sure enough he is a real doctor, here in WA. I called up the place listed as his employer and left a message of concern. They called me back and let me know he had retired in January (the month before his first terrible article was published) and thanked me for being a good citizen. I don’t know what happened with him, but it was frustrating because here my dad is like ‘see, a doctor says blablabla!’.

    1. *Sigh* I have in-laws like that. But perhaps the strain hitting your parents was pre-Delta variant.
      The course of the infection is so variable from person to person, that it is easy for folks to use all sorts of motivated reasoning to conclude that it isn’t that big a deal.

    2. The misinformation out there is a nightmare. And there’s a new study out of Yale that says unvaccinated people can expect to get Covid every year or so…or maybe it was every 18 months. And, of course, the more times you get infected, the higher the chance it will be deadly. And my folks didn’t get the Delta variant, so I have a feeling they’re going to contract it again. I hope they don’t end up learning the hard way.

  9. That you, Dr. Lickerman! I now feel I have a better grasp of the benefits (but also limitations) of “boosting”.
    My plan is to get boosted in a couple months, and I will try to make it shot of Pfizer since I got Moderna in me already.
    I will be back to teaching in-person this winter. The students should all be vaccinated, but I do want to shore up my defenses a little more.

    1. My question relates to Mark’s comment. Like him I had a couple of shots of the Moderna vaccine – last one in early Feb. My assumption is that, given the similarity in the constructs used, the two mRNA shots are broadly equivalent, with much of the difference accounted for by the higher original Moderna dose. Halving the dose for the Moderna third shot roughly flattens that playing field. So, while I can get either mRNA vaccine at work, I’d have to drive to get the JandJ – is there any justification to fight the traffic for the sake of a different vector?

      1. Agree that both mRNA boosters are likely to give you the same level of boost. J&J not quite as much. If I had decided to get a booster, I’d go with one of the mRNA ones. (Also, advantage of Moderna over Pfizer may not just be dose; the interval was greater for Moderna and we know that a longer interval between vaccine doses yields a superior response.)

  10. I got my 3rd Pfizer. I chronic kidney disease, straddling Stages 3A – 3B. It’s not affecting me so far, but I feel I have to be careful to protect my kidneys. I have heard that even asymptomatic COVID can cause damage to them. Is this true?

    1. There was an observational study that found 4.65 cases of end stage kidney disease per 1000 person years among people who had had covid-19 compared with 1.43 cases per 1000 person years among the general population. So, significant increase in relative risk, but small increase in absolute risk.

  11. I was listening to a WHO immunologist on the BBC the other day and she stated that since the pandemic is global, it would be a good idea for vaccine booster demand in the US and UK be diverted to production and supply in other countries (especially in Africa) where distribution of the initial doses has only reached 5% of the people in some countries. She reasoned that we will never get ahead of Covid as long as so many people are not yet immunized. Once a level of 70% worldwide (in a mobile economy) then we can start working on the 3rd doses. She expressed concern about the potential for variants to develop from which we aren’t protected by the current vaccines.

    I’ve had the Moderna course of two doses, in April of this year.

    What’s your take on that, Dr. Lickerman?

    1. I actually would have much preferred the U.S. had chosen to send vaccines to poor countries to do primary immunization there than offer 3rd doses to vaccinated people here. As you can probably tell from my post, I think 3rd doses here offer only marginal benefit. As vaccines are a limited resource, we would have been helping other countries–and ourselves–more by sending those vaccines to them. Definitely would help more to reduce the risk of new variants. (Though I think Delta or a sub-strain of Delta will predominate for quite some time. As Professor Ceiling Cat knows better than anyone, the most contagious virus wins; certainly possible to get a strain that’s more contagious than Delta, but in my view unlikely.)

  12. A very good point. Not just from a ‘solidarity’ point of view, but also from a purely ‘selfish’ one.
    Even highly vaccinated and boosted areas are prone to possible infection by new (less ‘vaccine sensitive’) variants from less vaccinated areas.

  13. At the risk of being pedantic, a small point: a second shot is a first booster shot, a third shot is a second booster. 😁

  14. I got the AstraZeneca vaccine early as part of the clinical trial. After about eight months, I was testing negative for antibodies. Participants in the trial were urged to get both Pfizer shots as there is no booster for the AstraZeneca vaccine yet. So, I have had four shots and have two different vaccine cards!

  15. My question is why are rich countries busy injecting boosters when the vaccines would be better sent to poorer countries with low vaccination rates? We would all be better off then as the benefits of boosters are surely low compared with the risk of new variants emerging from all over the world.

    I realise this is less a question than a pointed criticism of stupid governments.

  16. I’m in an odd position, having had a bone marrow transplant in February for CLL. I’m off the anti-rejection drugs now, but it’s pretty clear that I’m unlikely to make as strong a response to a vaccine as the average person. Third doses are available in my province for the immunosuppressed and nursing home residents. My first two were Pfizer, but I’m going with Moderna for #3 as it has better activity against the delta variant. I hope I feel some sort of reaction to it (there was disappointingly little to the first two) as an indication my borrowed immune system is doing something. It’s been a bit of a juggling act trying to get these done whilst redoing all the infant/childhood immunizations (as my new immune system is quite naive and has never even had a cold as yet! Wish the same were true of the rest of this old carcass.)

  17. I got my half dose of Moderna yesterday. No reaction. My arm has a bit of a twinge but nothing like ordinary jabs. We got ours this time from the local Pharmaca. The first two from the county health department.
    Now the chip in my arm tells be I have to report to internal security. Ha!

Leave a Reply