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By Karen Kier, pharmacist on behalf of the UN HealthWise team

The idiom “going too far” is used to describe a person who does something excessive or extreme. An example would be someone going overboard to prepare food for a party or spending an excessive amount of money on an item. Some might remember the 1987 romantic comedy Overboard starring Goldie Hawn and Kurt Russell. The film was a box office success and can still be seen on television. A 2018 remake of Overboard featured Anna Faris and Eugenio Derbez reversing the roles from the original film. Others might remember Adam Sandler’s 1989 film Going Overboard about a struggling comedian who works on a cruise ship.

So why am I talking about going too far when it comes to COVID-19? The FDA has cleared the way for a third, fourth, and fifth booster dose for COVID-19 mRNA vaccines.

There is confusion on this subject, especially in social media. It can be difficult to find good scientific answers to questions about boosters. There is significant debate in the media regarding the risk versus benefit of COVID-19 booster vaccines.

With the FDA announcement on booster doses, people who received Janssen (J&J) are eligible for a third dose of vaccine after an initial first dose and then a second booster shot. The third dose for those who received J&J should be an mRNA vaccine (Moderna or Pfizer). For an individual who has received the first and second doses of the mRNA vaccines, as well as the first booster dose (3rd dose), they may be eligible for a 4th dose of the mRNA vaccine. A person who has received four doses of mRNA vaccine due to a weakened immune system such as cancer or autoimmune disease may be eligible for a 5th mRNA vaccine. The FDA has approved another mRNA booster for people 50 and older or those 12 and older who have compromised immune systems. Currently, people under the age of 50 with sufficient immune systems are not eligible for the next round of boosters. Data shows that younger people have a more sustained or longer lasting antibody response to COVID-19 vaccines than older people.

The benefit of additional booster doses of mRNA vaccines comes from studies with the Omicron variant. Israeli studies show protective benefit against severe illness and death from COVID-19 with an additional booster (4th dose). The goal of the Omicron variant and vaccines is to reduce serious illness rather than prevent infection. Additional doses of mRNA vaccine showed benefit although marginal improvement. As one article stated, a marginal benefit is always a positive step forward in reducing serious consequences and deaths. The recall provides a good reason to protect the most vulnerable groups against serious diseases.

The most critical information regarding the supplemental booster is the timing of vaccine administration. Data support a minimum of four months since the last vaccine administration. This is important because the body may have an inadequate response if given too soon. Some data suggests that five to six months may be a more valuable amount of time between reminders. This interval has more to do with maximizing the ability of the immune system to mount the best defense against the virus. The Israeli study with Pfizer reported that the second booster increased antibodies 5-fold, but antibodies aren’t the only story that provided protection. Ultimately, it’s about training the immune system to recognize and defend the body against serious COVID-19 infections. A CDC study evaluating the U.S. push for Omicron proved that mRNA vaccines were still 79% effective against death and mechanical ventilation (respiratory support) with just two of the original doses, but showed 94% efficacy in those with a two-dose serial vaccine plus a booster.

Some of the concerns circulating, even among experts, are whether too many doses of the COVID-19 vaccine may be bad for the immune system. This is where social media confused the issue. Science argues that if the time interval is at least four months between vaccine doses, the immune system will not be overloaded and can respond adequately. Therefore, the lead time is critical! Other disadvantages of getting extra booster doses include the repeated side effect profile (very similar to the first doses) and the cost and coverage of the vaccine since the government has announced that it cannot afford to pay for additional doses. A more global concern is that the United States is donating more vaccines while other parts of the world have not had access to the first doses of vaccine.

This is a great opportunity to talk to your healthcare professional about the right time to get vaccinated against COVID-19.

Please feel free to call the UN HealthWise Pharmacy for Science on COVID-19. UN HealthWise offers vaccines against COVID-19 and influenza Monday to Friday from 4 p.m. to 6 p.m. Call the pharmacy for an appointment for other time slots. The UN HealthWise pharmacy offers Moderna, Pfizer, and high-dose influenza vaccines and influenza vaccines. Call the pharmacy for more information.

UN HealthWise Pharmacy

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