COVID Booster Shots: What Is A Booster Shot and Will You Need One?

There's a lot of confusion and a lot of questions around COVID Booster Shots, like what are they and will I need one? And guess what? I have answers. So, today we're going to touch on five questions about booster shots.

1.  What is a booster shot?
2.  Which immunizations already require booster shots?
3.  Is the COVID-19 booster new or is it the same shot?
4. When is a booster shot not really a booster?
5. Who needs a COVID-19 booster shot?

1.  What Is A Booster Shot?

In order to understand what a booster shot is, you first need to have a pretty good concept of a vaccination. A vaccination is an injection that is meant to make your body build up immunity or antibodies against certain viruses and certain bacteria. When you are injected with a vaccine or when you are vaccinated, you are actually being given either a weakened or an inactive version of a virus, bacteria or you're being injected with the genetic blueprint that would allow your body to recognize a virus or bacteria if you're attacked. This vaccine would allow your body to build up an immune system and fight the infection. So, basically, vaccines allow you to get the immunity to protect yourself from getting really sick without ever actually having to have the real infection.  In order to learn more about vaccinations, please be sure to watch my video on how vaccines work, "The Truth About Vaccines."

Why Do We Need Booster Shots?

Over time, after you get vaccinated, for most people, the immunity tends to wane. It tends to decrease. Over time, those antibodies that you got initially after being vaccinated will decrease and you'll have less protection. That's why we get booster shots. The booster shots reintroduce your body to the vaccine so that it can be revved up and you get a fresh immunity. You get more antibodies, and more protection so that you're able to fight off the infection.

2. Which Immunizations Already Require Booster Shots?

Booster shots are not new. We've been getting immunizations all of our lives and we've been getting booster shots all of our lives. Sometimes the booster shots will come within weeks, months, or even within years. It depends on where you are traveling, whether or not you need a booster. Sometimes it depends on your occupation. For example, if you're a healthcare worker, there may be certain boosters that are required.

So, which immunizations already require boosters? Well, just to name a few, the MMR requires a booster, measles, mumps, and rubella. Hepatitis A, varicella vaccination (chickenpox vaccine), tetanus, Diptheria, pertussis, all require boosters.  The point is that boosters are not new. Just as you've been getting vaccinated, most of us, all of our lives, we've been getting booster shots just to make sure that we maintain this protection against the various viruses and bacteria.

3. Is The Covid-19 Booster New Or Is It The Same Shot?

So, when it comes to the COVID-19 vaccination or booster, is the booster for COVID-19 different, or is it just the same original shot from the COVID-19 vaccination series? Well, let's talk about it.  First off, what exactly is the COVID-19 vaccination? Well, there are several different types. The three that are most familiar in the United States, that have been used, are Moderna, Pfizer, and Johnson & Johnson.

Moderna and the Pfizer Vaccines

The Moderna and the Pfizer are messenger RNA vaccines, meaning that your body is introduced to a genetic blueprint for COVID-19. It's given a messenger RNA of the spike protein. And so, you're not actually injected with the COVID-19 virus. You cannot actually get COVID-19 from these vaccinations. You're just given a blueprint of that spike protein. Your body then takes that and it makes antibodies to rev up so that if ever you actually are introduced to the real COVID-19 infection, you already have antibodies without having had to go through the actual infection.

Johnson & Johnson vaccine

The Johnson & Johnson vaccine is a little different. It's actually carried through an adenovirus vector, but still, you cannot actually get COVID-19 the disease from the vaccine. It still introduces your body to the material that it needs to see in order to rev up the immune system. Be sure to watch my video on the Johnson & Johnson vaccine after you finish reading this article.

So, what is the deal with the COVID-19 boosters? Well, as I mentioned, after you get an initial vaccination, with many of the vaccines, over time your immunity, or your protection, tends to wane or decrease. The same thing is likely happening with the COVID-19 vaccines. There have been various studies, many of them are pre-print, and have not been peer-reviewed, but there have been various studies to suggest that with the COVID-19 vaccinations, the antibody protection that you have initially, over time it starts to decrease. And the fear is that if you have a decrease in immunity, then you're more likely to get the COVID-19 infection. With that, the idea of the COVID-19 booster has arisen.

So, the question I get a lot is, "Hey, with this new COVID-19 booster, is it a new vaccine that gives us protection against the different variants like Alpha, Delta, Mu, and other variants that are here or maybe even to come?  Or is it the same old vaccine that we got in the original series?"

When the concept was originally brought up about the COVID-19 booster, well, it's just the same vaccine. It's the same vaccine meant to rev up your immunity, but not with the new variants. Now, there is research being done where there are vaccinations being studied that are actually incorporating some of the new variants that we have seen, including the Delta variant. These things are in research.

But at the time that the COVID-19 booster shot was first presented, we're simply talking about the same vaccine that was given in the original series just being given a matter of time later. It's given some months later, in order to rev up the immunity. So, the booster shot, originally anyway, is not a new vaccine for the new variants. It's the original vaccine from the original series.

4. When Is A Booster Not Really A Booster?

So, when is a booster not really a booster? I mentioned that by definition you think of a booster shot as being something that will rev up immunity that has started to wane. But sometimes, even though we use the word booster, a booster is not really a booster. What do I mean? Well, studies have shown us that people who are immunocompromised often do not actually get the full protection, even with the original series from COVID-19.

For example, patients who have received solid organ transplants like kidney transplants, also patients who have HIV that is not controlled, if they have high viral loads or low CD4 counts. If you have other immunocompromised patients like patients taking medicines for multiple sclerosis or rheumatoid arthritis.  This also includes patients who have immune systems that are compromised, even when they get the two doses of the messenger RNA, Pfizer, and Moderna, or one dose of the Johnson & Johnson vaccine when you compare them to people who have normal immune systems. People who are not immunocompromised, many of them never got the immunity that we wanted them to get in order to protect themselves from COVID-19.

So, in these patients, it is already being recommended that they get booster shots. In other words, if they've already gotten two doses of the messenger RNA series, we recommend that they go ahead and get a third dose. This is not necessarily because their immune systems have waned, it's because they never got the immunity. And so, that booster is not really a booster because it's not boosting a waning or decreasing immune system. Instead, it's really the completion of the immunity that they never got initially.

So, when is a booster not really a booster? Another example is the flu vaccine, the vaccine for influenza. We get a whole different influenza vaccine each year because it changes depending on what flu season looked like last year, or what the flu season is looking like in other parts of the world. And so, essentially, you're getting a brand new shot every year, not just a boost of the same shot.

5. Who Needs COVID Booster Shots?

There has been data out suggesting that the COVID-19 vaccination immunity wanes, at least the antibodies wane, over time. One study suggests that every two months you have a decrease in efficacy of about 6% of the vaccines. There was another study that showed when you look at patients who were fully vaccinated in March and you compared them with patients who were fully vaccinated in January, the patients who were fully vaccinated in March had better protection against severe illness from COVID-19 and better protection against testing positive for COVID-19.

This data in and of itself suggests that the farther you are from being fully vaccinated, the weaker your immunity or the more your immunity has waned. Again, there's a lot of data that's coming out. Some of it has not been fully reviewed. For some of it, we need more time, and we need more data. Some of the data is pre-print, but these are some of the things that are out there.

Israeli Data On Booster Shots

We also have some Israeli data. Now, they looked at about a million patients over the age of 60 who received booster shots. And they found that when they looked at their antibodies and assessed their protection, there was a significant relative risk reduction in getting severely ill with COVID-19 and from getting infected with COVID-19 in the patients who received the booster shots. Again, a lot of this data has not been fully reviewed, some of it is pre-print, and there are many questions. For example, what is the definition of severe COVID-19 in the Israel data versus what we've seen in some of the data in the United States? Those distinctions can make a difference in how we interpret the data. Also, what are the other confounding factors?

When you're looking at observational data, then you're not comparing it to a placebo group. You don't have a randomized controlled trial. So, again, just because I'm presenting the data, that does not mean that it has been fully vetted. I just want to give an idea of what data we're looking at when we say that certain people need boosters.

Other Data That May Influence The Decision On Who Needs To Have A Booster Shot

For every 100 people, you look at who is being hospitalized with COVID-19, and 95 of them are unvaccinated and only five of them are fully vaccinated. That lets you know that, by far, most of the people being hospitalized are unvaccinated, about 95%. But then when you look at the five people who are vaccinated and hospitalized, most of them are either elderly or have some type of an immunocompromised state.

If we look at that data as far as influencing who needs boosters, then instead of just vaccinating everyone with a booster, we may say, "Hmm, if the five people out of the 100 who are actually vaccinated and hospitalized are elderly and immunocompromised, then perhaps that group will be the group to benefit from the booster vaccine."

And this leads to the answer to the question, "Who needs to be vaccinated with a booster?"

Who needs a booster shot?

Now, I will say that I believe and most physicians and scientists believe that at some point, likely everyone will need a booster for the COVID-19 vaccine, but we have to talk about the here and the now and what are the end goals and the point of the booster. If the point of the COVID-19 vaccine is to keep people from getting severely ill and to keep people from dying from COVID-19, well, guess what, the vaccinations are still working, even without the booster in most people, certainly in most young healthy people.

Why, because we know that a very small percentage of people who die and a very small percentage of people who are severely ill with COVID-19 are fully vaccinated. By far, well over 90% of the people who are very ill and who are dying from COVID-19 are unvaccinated, and that's even without putting boosters in the picture.

In fact, there was actually a study that reviewed the data, even since the Delta variant, as far as which patients still had protection from being hospitalized. And we found that with the Moderna vaccine, patients had a 93% protection against getting hospitalized, with the Pfizer vaccine an 88% protection, and with the Johnson Johnson vaccine a 71% protection.

That means that even without a booster, these people who are fully vaccinated have these high percentage protection rates against getting very sick, and against getting sick enough to go to the hospital. That means that the vaccinations are still working, even without a booster, in these people. And just to put things in perspective, because some people might think, "Oh, 71%, that's not good,"  if you look at the flu vaccine (influenza vaccination), it only has about a 40% to 60% effectiveness from year to year. But, that does mean it will still protect you. You have a great chance of it protecting you from getting severely ill or dying from COVID.

My point is that these numbers, 93%, 88%, 71% protection against getting very sick from COVID-19, even with the original vaccination series, and no booster, means that the vaccinations are still doing their job as far as keeping us from dying from COVID-19 or getting very ill. So, if you are a healthy person, at least as the data stands, if you're fully vaccinated, then you're probably still doing all right.

FDA Advisory Board Recommendations For Boosters

But what about those people who meet the percentage points of the folks who are fully vaccinated and still getting sick enough to go to the hospital? Well, those folks may need a booster. So, who needs a booster? At least with the initial review of the data, albeit limited data, it looks like the people who the FDA advisory board recommends to get boosters are the people who are elderly or over 65 years of age and people who are immunocompromised.  In other words, people who are at the highest risk of getting severe COVID are being recommended to get COVID booster shots.

Booster Shots For Groups That Have High Exposure To Covid-19

There's another group that even if they are healthy, young, and even if they are not at risk for severe COVID, this group has high exposure to COVID-19 and they may also need booster shots. Again, this is an evolving, dynamic conversation, but let's just talk about it.

If you look at healthcare providers, like respiratory therapists who are the ones right there dealing very closely with patients with COVID-19. When you look at physicians who are seeing patients with COVID-19 every day up close. The frontline workers, such as teachers who are teaching students, especially the elementary school children who are not even eligible for the vaccination, then you have teachers who are at high risk and being exposed.

Even if they're young, healthy, and fully vaccinated, if they're around a lot of people who have COVID-19, then they still could get infected. Now, if they get infected, will they be sick enough to die or to be hospitalized if they're fully vaccinated? Not likely. But if healthcare workers and teachers are infected, even if they're not very sick, they have to stay home, and this could add to the shortage of healthcare providers. This could add to the shortage of teachers.

Should Frontline Workers, Teachers, and Physicians Be Offered Boosters?

I actually believe that frontline workers, healthcare providers, and teachers should be offered boosters. Here's the most important point. We need to use the data we have and the tools we have to fight this COVID-19 pandemic. Right now, if you are eligible to get the COVID-19 vaccination, please understand that the vaccinations are safe and they are effective.

If you are fully vaccinated, you have a very, very low chance of dying from COVID-19 or getting severely ill. If you look at the hospitalizations, well over 90% of the people who are sick enough to go to the hospital with COVID-19 are unvaccinated. So, please, if you're eligible, get vaccinated.

Also, please wear your masks and wear them properly. Make sure they cover your nose and that they fit snugly to your face. Wearing masks can help to prevent the spread of COVID-19. And as far as these boosters, be patient. Follow the data, the FDA recommendations, and follow the CDC guidelines.

If you are 65 and older, yes, get your booster. Immunocompromised?  Yes, get your booster. If you fall into one of these other categories, keep paying attention to the science, keep watching the recommendations. Consult with your physician to find out if you are a person who should get a booster shot.