closeup of booster shot bottle
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Without federal health and regulatory agencies taking a strong position on a second COVID-19 booster shot, confusion abounds over who should get boosted, and when.

Acts Retirement–Life Communities Vice President and Chief Medical Director Paul Reinbold, M.D., sought to wade through the information and the confusion during Wednesday’s LeadingAge membership call.

The Food & Drug Administration determined that the known and potential benefits of a second booster with the mRNA vaccines (Pfizer–BioNTech or Moderna) outweighed the known and potential risks in people aged 50 or more years. The U.S. Centers for Disease Control and Prevention then announced that there was additional benefit to a second booster dose, particularly in individuals over age 50 with certain health conditions, immunocompromised individuals and anyone over age 65.

Neither agency, however, provided a clear indication to recommend a second booster dose to members of all of those approved groups. The result is that getting a second COVID-19 booster dose is, effectively, an individual decision.

When the first booster dose was authorized, it was recommended for anyone over age 50 who was fully vaccinated — defined as two doses of the Pfizer-BioNTech or Moderna vaccines, or a primary vaccine and booster dose of Johnson & Johnson’s Janseen COVID-19 vaccine — to get boosted. 

Adding to the confusion, Reinbold said, was the recommendation for a third dose of a COVID-19 shot — not classified as a booster — given at least four weeks after the second dose for those in the immunocompromised group. Reinbold said there will be a subset of individuals who should get a second booster after their third dose, which actually would represent their fifth dose of the vaccine in total.

For the rest of the population, Reinbold said, there are several considerations on whether a fully vaccinated individual who already has received one booster dose should get a second booster dose.

Although the first booster dose provides additional efficacy and has been shown to dramatically reduce hospitalizations and deaths from the coronavirus, he said, the evidence backing a second booster dose for younger, healthier individuals is less clear.

Reinbold said that general agreement exists that immunocompromised people, those with multiple comorbidities, and the “oldest of the old” are most likely to benefit from a second booster and should be recommended by their primary care physician to receive it. 

For younger, healthier individuals — even those who work in long-term care settings — Reinbold said, the benefits are smaller. He pointed to an Israeli study in young, healthy workers in healthcare settings that showed that a second booster provided little benefit. That said, he added, a sudden increase in cases and severe illness, and a greater risk for catching and transmitting the virus, might be indicators that it is time to get that second booster shot.

Communities have another tool in their arsenal for individuals who forgo boosters or vaccines, he said; antiviral treatments have shown to decrease hospitalizations and deaths by 90%. 

Community response

Senior living groups have called on the Biden administration to renew the public-private partnership on vaccine and booster shots. 

Acts Retirement–Life Communities, Reinbold said, will make second booster disease available to residents and staff members who are aged more than 50 years and have high-risk medical conditions, as well as to immunocompromised individuals, through on-site clinics. Immunization clinics also are available to relatives of staff members.

Acts Retirement–Life Communities continues to partner with CVS Health and its institutional pharmacy, Omnicare, to provide vaccinations on site, although it refers ambulatory independent living residents and staff members to CVS retail pharmacies for shots, he said.