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Here's who can and can't get a COVID-19 booster shot now

The CDC approved booster shots for millions of Americans. But the Verify team breaks down who is on the list.

WASHINGTON — Millions of Americans over 65, as well as adults dealing with underlying conditions, are now recommended to get a COVID-19 booster shot, after CDC Director Rochelle Walensky signed off on recommendations from an advisory committee. 

The health agency director also overruled the advisory committee, recommending booster shots for those working in occupational settings with a high risk of transmission. 

THE QUESTION:

Who can get a COVID-19 booster shot now based on CDC guidance?

SOURCES: 

THE ANSWER:

Those who got the Pfizer vaccine 6 or more months ago and are 65 or older, between 18 and 64 with an underlying medical condition and people aged 18-64 years who are at an increased risk for COVID-19 exposure and transmission because of occupational or institutional setting are able to get a booster. 

The Verify team is breaking down all the rules for each category below. 

WHAT WE FOUND:

Pfizer Vaccine Recipients Aged 65 And Older:

According to our experts, patients who are 65 years and older, who received the Pfizer vaccine, are now recommended to get a booster shot, after six months. A CDC statement read as follows: 

"People 65 years and older and residents in long-term care settings should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series," the statement read. 

This recommendation from Walensky aligned with recommendations from the CDC Advisory Committee on Immunization Practices (ACIP).

Pfizer Vaccine Recipients Aged 50-64 With Underlying Medical Conditions:

According to our experts, patients aged 50-64 years old are recommended to get the booster shot after six months, if they are dealing with an underlying medical condition. 

Underlying conditions include heart disease, high blood pressure, lung disease, obesity and diabetes. A full list of underlying conditions can be found here.

"Their protection is to some degree waning after six months," said Dr. William Schaffner from Vanderbilt University School of Medicine. "And if you give them an additional dose of the booster, their antibodies will rise up very, very quickly." 

This recommendation from Walensky aligned with recommendations from the CDC Advisory Committee on Immunization Practices (ACIP).

Pfizer Vaccine Recipients Aged 18-49 With Underlying Medical Conditions:

According to our experts, patients aged 18-49 with underlying medical conditions are now eligible to receive a booster shot six months after the first two jabs.

For these patients, it is recommended that they speak with their doctor before getting the vaccine. 

"This is more commonly referred to in medical language as 'shared decision making' where you speak to your physician and say 'should I get this booster,'" Schaffner said. 

This recommendation from Walensky aligned with recommendations from the CDC Advisory Committee on Immunization Practices (ACIP). 

Pfizer Vaccine Recipients Aged 18-64 Who Are At An Increased Risk Due To 'Occupational or Institutional Setting':

After a close vote, the CDC's advisory committee did not recommend a booster shot for people in this situation. However, Walensky made the decision to overrule the committee. 

The CDC director recommended the booster shot for people who are at an increased risk due to working or living in an "occupational or institutional setting." The full recommendation was as follows: 

"People aged 18-64 years who are at an increased risk for COVID-19 exposure and transmission because of occupational or institutional setting may receive a booster shot of Pfizer-BioNTech's COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks."

Our experts said that "occupational or institutional settings" likely includes millions of Americans. 

"It certainly would include healthcare workers," Adalja said. "People have also suggested that it includes teachers. Obviously, they're dealing with unvaccinated groups of the population because people under the age of 12 are not eligible to be vaccinated in the United States. There may be other individuals who would deal with the public on a very high basis." 

Adalja said that CDC guidance is likely to come out, better defining "occupational or institutional settings," although in practice, people may have broad access to these shots. 

"In practical terms, I think it probably means anybody who wants a booster can get a booster," he said. "Because anybody can say my occupational exposure and my own personal risk preference are such that I want to have a third dose of the vaccine." 

There was some backlash within the scientific community, in response to Walensky's decision. Some critics wanted her to follow the suggestions of the ACIP. 

"The ACIP recommendations have only ever been overruled once before," Adalja said. "So this is not a common thing to happen. And I think that we deserve an explanation for why she overruled her own advisors." 

Moderna Or Johnson And Johnson Vaccine Recipients: 

The CDC recommendation on boosters only applies to Pfizer vaccine recipients. Those who received Moderna or Johnson and Johnson vaccines are not currently recommended to get a booster. 

"Pfizer came first and presented those data," Schaffner said. "Now Moderna is coming along second. Those data have been submitted. Johnson and Johnson is soon behind. So we will have more information as we go along." 

As of now, the CDC does not recommend "mixing and matching," in which a recipient of Moderna or Johnson and Johnson vaccines would go get a Pfizer booster. 

"We don't think there's real harm in that," Schaffner said. "But we haven't seen data. And without data, it is very difficult to make a recommendation about what we call 'mixing and matching.'"

Adalja also cautioned people away from 'mixing and matching,' saying that a decision on further booster shots is likely on the way. 

"There's going to be a decision about Moderna in the next couple of weeks," he said. "We know that Moderna has already submitted information on their third dose to the FDA. There will be a similar process for Moderna. So I don't think it's necessary for people to do this right now."

Immunocompromised People: 

Technically immunocompromised people do not receive 'boosters,' but rather they receive a third shot. 

"Immunocompromised people are recommended to get what we call a 'third dose,'" Schaffner said. "You see, these folks didn't respond optimally to the first two and that third dose will help many of them achieve a normal level of protection." 

According to the CDC, people with "moderately to severely compromised immune systems" are recommended to get a third dose. 

"This additional dose (is) intended to improve immunocompromised people's response to their initial vaccine series," the CDC wrote

The CDC recommends that immunocompromised people get an additional dose of the vaccine at least 28 days after their second shot of either the Pfizer or Moderna vaccines. 

According to the CDC, immunocompromised people include the following: 

  • Been receiving active cancer treatment for tumors or cancers of the blood
  • Received an organ transplant and are taking medicine to suppress the immune system
  • Received a stem cell transplant within the last 2 years or are taking medicine to suppress the immune system
  • Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • Advanced or untreated HIV infection
  • Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response