COVID-19 booster shots: Will I need a fourth vaccine dose? – CNET

Another COVID-19 booster shot could become a standard recommendation as early as March. Here’s what we know today.
Will we need four — or more — vaccine shots to combat omicron and other COVID variants?
On Monday, the Food and Drug Administration approved a booster of Pfizer‘s two-dose COVID-19 vaccine for healthy kids 12 and up and for those 5 and up with compromised immune systems and other specific health issues. But with the rapidly spreading omicron variant overcoming standard vaccine protocol, a new question arises: If three shots are the new normal, will a fourth dose soon be necessary? 
The Centers for Disease Control and Prevention updated its guidance to indicate that immunocompromised people can get a fourth COVID-19 shot, while Israel, Germany and other nations are researching the efficacy of a fourth shot for the general population.

White House chief medical adviser Dr. Anthony Fauci has said that a fourth jab is a possibility in the US, too.
“It is conceivable that in the future we might need an additional shot, but right now, we are hoping that we will get a greater degree of durability of protection from that booster shot,” Fauci said at a White House briefing Dec. 29. “We’re going to take one step at a time, get the data from the third boost and then make decisions based on scientific data.” 
COVID-19 vaccines, especially with a booster, have proven to be highly effective at preventing serious illness from the virus, even from the omicron variant. People who are unvaccinated are 10 times more likely to be hospitalized if infected. 
Here’s what we know about additional booster shots from Pfizer, Moderna and Johnson & Johnson, plus info on what it means to be “fully vaccinated,” updates to travel rules for international travelers and the latest on the federal vaccine mandate.
By mid-December, more than 200 million Americans were considered fully vaccinated against the COVID virus with either two doses of the Moderna or Pfizer vaccine or one dose of Johnson & Johnson’s.
But it may be time to redefine what “fully vaccinated” means: By October, it became apparent that isn’t enough to sustain COVID antibodies long-term, especially against potent strains like the newer omicron variant: One study from the UK’s Health Security Agency indicated protection waned as much as 65% after just 10 weeks.
Some medical experts are suggesting we consider three shots as a new baseline.
“I think we will stop calling people with two shots fully vaccinated within a week or two,” Robert Wachter, the chair of UCSF’s Department of Medicine, said in an online discussion last month hosted by the San Francisco Chronicle. “I just think they’re not. I wish they were,” he said. “Omicron is going to make that case quite vivid.”
Nearly 100 million Americans have received a booster shot but even before the omicron variant emerged, disease experts were already considering the need for an annual booster to top off protection as the effectiveness waned and new variants emerged. 
According to UCSF’s Wachter, it’s still too early to know how protected those who received the J&J vaccine are. “There’s always someone who got J&J and says, ‘What about me?’ And the answer is, we have no idea,” Wachter said. “Do they need a third shot? I think that question is going to be important to answer.”
According to a Dec. 29 study by the South African Medical Research Council, for individuals who received one dose of the J&J vaccine, known as Ad26.COV.2, a booster delivered six to nine months later raised their odds against hospitalization from 63% to 85%
It’s the earliest proof of the Johnson & Johnson booster’s effectiveness, the author of the non-peer-reviewed study wrote. And it comes at a time when the more contagious omicron variant is running rampant. In the period examined — mid-November to mid-December 2021 — omicron infections in South Africa represented 98% of all confirmed COVID cases, according to GISAID. (In the US, omicron is responsible for more than 58% of all new infections, according to the US Centers for Disease Control and Prevention.) 
It’s possible the J&J vaccine, associated with a rare but serious blood-clotting issue, may make a better candidate for a booster,  regardless of which vaccine you initially received. A new analysis of “mixing-and-matching” shots conducted by Beth Israel Deaconess Medical Center found a J&J booster given to individuals who initially received two doses of Pfizer’s mRNA vaccine generated a 41-fold increase in antibody response within a month, compared to only a 17-fold increase when given another Pfizer jab.
The J&J booster also generated a fivefold increase in T-cells that fight omicron within two weeks, the company said, compared to a 1.4-fold increase with a second dose of Pfizer’s formula.  
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Scientists in Germany, Israel, the UK and other countries are considering a fourth shot of a COVID-19 vaccine for the general public. Fauci said a fourth jab is “conceivable” in the US, too.
The omicron variant is changing the definition of full vaccine protection, Ugur Sahin, CEO of BioNTech, which makes a vaccine in partnership with Pfizer, said in a statement. “With the data now coming for the omicron variant, it is very clear our vaccine for the omicron variant should be a three-dose vaccine.” 
If three doses of the Pfizer COVID-19 vaccine are needed to protect against omicron, the timeline for a fourth shot could be pushed up to as early as March, Pfizer executives said.
“I think it is very likely that we will need a fourth booster, possibly already this spring, particularly if omicron continues to dominate,” Mikael Dolsten, Pfizer’s chief scientific officer, told CBS News.
In October, the CDC approved a fourth booster shot of an mRNA vaccine, like Pfizer’s or Moderna’s, for individuals who are immunocompromised or have other specific health issues. 
“I think we will need the fourth dose,” Pfizer chair Albert Bourla told CNBC in December. Bourla initially projected a waiting period of a full year after a third dose but, with omicron, “we may need it faster,” he said.
“There are vaccines like polio [where] one dose is enough,” Pfizer’s Bourla said back in April. “And there are vaccines, like flu, that you need every year. The COVID-19 virus looks more like the influenza virus than the poliovirus.”
Executives said the companies are gathering data on the effectiveness of Pfizer-BioNTech’s current vaccine, Comirnaty, against the fast-spreading variant and, in parallel, experimenting with an omicron-specific vaccine. that could be ready by March 2022, pending regulatory approval. They’re also looking at a multivariate vaccine that could protect against other strains, such the original alpha variant and more virulent delta strain.
Masks and vaccines check COVID’s spread.
Like Pfizer, Moderna said it’s testing the effectiveness of its COVID-19 vaccine, SpikeVax, against omicron. The company has offered little specifics but said a variant-specific shot could be available in early 2022.
Moderna President Stephen Hoge said we’ll most likely need annual COVID boosters, much like we do with the flu, at least to protect with the highest risk of infection and serious illness. Moderna is working on omicron-specific boosters, Hoge told Reuters, but realistically they won’t be on the market “before March and maybe more in the second quarter.” 

Its current booster is a 50-microgram dose, and while the company has also reported a 100-microgram dose of Spikevax has proven exponentially effective against omicron, it does not plan to seek approval from the FDA for the double-dose.   
A study of 69,000 health care workers released last week by the South African Medical Research Council found that, for those who already received the J&J vaccine, Ad26.COV.2, a booster given six to nine months later raised their odds against hospitalization from 63% to 85%.

The research was conducted between mid-November and mid-December 2021, when the omicron variant represented 98% of all confirmed COVID cases in South Africa, suggesting the vaccine offers strong protection against the highly contagious strain.
“This adds to our growing body of evidence which shows that the effectiveness of the Johnson & Johnson COVID-19 vaccine remains strong and stable over time, including against circulating variants such as omicron and delta,” Dr. Mathai Mammen, global head of Janssen Research & Development, a pharmaceutical subsidiary of Johnson & Johnson, said in a statement.
For more on COVID-19, here’s how the new omicron variant is different from the delta strain, what to know about the Moderna COVID booster and how to choose which booster shot to get.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

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