This is When You Can Get COVID BOOSTER SHOT 

By  Dr. Mike Hansen

Whether or not you are immunocompromised (have a weakened immune system), we now have answers to when you can get a COVID booster shot. If you had either the Pfizer or Moderna vaccine.

There are about 9 million people in the US who are considered to be at least moderately immunocompromised. These are mostly people taking powerful immunosuppressive medications, like transplant recipients, cancer patients, and those with severe auto-immune conditions. Their immune system’s ability to respond to the covid vaccine is blunted, with a decreased antibody response. Vaccine effectiveness is estimated to be around 60-70% in immunocompromised people, compared to 94% overall.


According to the CDC, data shows that vaccinated immunocompromised people have accounted for a large portion of COVID hospitalizations. They are 485 times more likely to end up in the hospital or die from Covid than non-immunocompromised vaccinated people. Also, immunocompromised are more likely to spread the virus, despite making up only 3% of the population.

But can we actually expect a booster shot to help them?
There is currently an observational study at Johns Hopkins that is yet to be published. They looked at people who received the 3rd dose. Based on that, the booster shot did help some of them to achieve higher antibody levels. Last week, the FDA gave EUA the booster shot for some immunocompromised people, with the CDC’s recommendation. So this is for both Moderna and Pfizer. But so far, there’s not enough available data to move forward for a booster shot for the J&J vaccine.

According to the CDC, this EUA is intended for people who have moderate to severe immunosuppression and not people with chronic conditions for which there might be mildly associated immunosuppression. For example, people with diabetes, chronic kidney disease, chronic liver disease, and COPD have some degree of immunosuppression. Still, it’s not on the same level as the other conditions I mentioned. But you have people that fit into a category that is a real grey area, for example, someone with rheumatoid arthritis taking drugs like methotrexate, hydroxychloroquine, leflunomide, or sulfasalazine, or drugs like Humira and other biological agents.

According to the CDC, someone considered to be moderate to severely compromise in general would be someone:
• receiving active cancer treatment
• someone with an organ or stem cell transplant
• Advanced or untreated HIV infection
• Someone getting high dose steroids for a prolonged time
• Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)

Basically, the CDC is leaving it up to patients and their doctors to decide who needs an extra dose and when they should get it. And apparently, there won’t be a requirement for a doctor’s note or prescription. And so if that’s the case, basically anyone can say they are immunocompromised to get a booster shot….unless those administering the vaccine require proof of a qualifying immunocompromised condition. So that’s a messy situation that the CDC should further clarify. Otherwise, pretty much anyone can lie and get a 3rd shot.

And so what about those who are not considered to be immunocompromised?
The Biden administration is working on a plan for most Americans to get booster shots eight months after becoming fully vaccinated. So based on the initial vaccines given to health care workers and high-risk elderly groups in December, that means the booster will be distributed in September. Pfizer submitted initial booster shot data to the FDA, which showed that when compared to 2 shots of the vaccine, their booster shot triggered a much higher antibody response against the initial strain of SARS-CoV-2, in addition to the Delta and Beta variants.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine

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