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All fully vaccinated adults can now access additional booster shots for the Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines. Justin Sullivan/Getty Images
  • The FDA and CDC are allowing all vaccinated adults to be eligible for a COVID-19 booster shot.
  • All adults who received the Pfizer-BioNTech or Moderna mRNA vaccines are eligible for boosters 6 months after their second dose.
  • People over 18 who received the one-dose Johnson & Johnson vaccine were already eligible to get an mRNA booster after 2 months.
  • While the vaccines continue to provide protection from serious disease and hospitalizations, the effectiveness of the vaccine against breakthrough or mild infections wanes over time.
  • To get the pandemic under control, experts agree that more unvaccinated people still need to get their first shots.

After rolling out COVID-19 mRNA boosters in September and October to high-risk Americans, federal health officials broadened access to all adults.

The Food and Drug Administration (FDA) expanded the emergency use authorizations for both the Pfizer-BioNTech and Moderna-NIAID boosters on November 19 to include all people 18 and older.

Later that day, Centers for Disease Control and Prevention (CDC) Director Dr. Rochelle Walensky signed off on the boosters, hours after the agency’s vaccine advisory group endorsed expanding eligibility to all adults.

Now, anyone 18 years or older who received an mRNA vaccine for their primary series is eligible for a booster at least 6 months after their second dose.

Individuals 18 years or older who received one dose of the Johnson & Johnson vaccine were already eligible for a booster at least 2 months after their dose.

The CDC and FDA previously authorized mix-and-match boosters, so people eligible for a booster are free to choose any of the approved or authorized vaccines for the extra dose.

Although all adults are now eligible for a booster, which people should seek one out as soon as they are eligible?

Dr. Albert A. Rizzo, the chief medical officer of the American Lung Association, said the decision of the CDC and FDA — and certain state and local authorities — to open up boosters to all adults “boils down to mitigating risk, as well as trying to stem what seems to be a surge [of the coronavirus] in different parts of the country.”

Public health officials are also responding to research showing that the protection against infection offered by the mRNA vaccines wanes during the months after the second dose.

In spite of that waning, “vaccines have been effective, as far as keeping people from getting critically ill and needing hospitalization,” said Rizzo.

Many of the people who may benefit the most from boosters are those who were already eligible for them.

Adults who received one dose of the Johnson & Johnson vaccine were already eligible for a booster, because the protection offered by one dose of this vaccine is lower than two doses of the mRNA vaccines.

In addition, Rizzo said the CDC and FDA, in their earlier decisions on mRNA boosters, “really did open up boosters to the people who are at highest risk [from COVID-19] — the elderly and those who have compromising comorbidities.”

Fully vaccinated people with underlying medical conditions are more likely to have severe COVID-19 if they do get infected.

In addition, older adults may generate less of an immune response to the initial vaccine series, so a drop in protection in the months after their second dose can put them at even more risk.

The CDC’s list of underlying medical conditions includes:

  • cancer
  • chronic kidney disease
  • chronic liver disease
  • chronic lung diseases
  • dementia or other neurological conditions
  • diabetes, type 1 or type 2
  • down syndrome
  • heart conditions
  • HIV infection
  • immunocompromised state (people in this group are already eligible for an additional dose, but the CDC does not currently recommend a booster dose after that additional dose)
  • mental health conditions, including anxiety, depression, schizophrenia
  • overweight and obesity
  • pregnancy
  • sickle cell disease or thalassemia
  • smoking, current or former
  • solid organ or blood stem cell transplant
  • stroke or cerebrovascular disease
  • substance use disorders
  • tuberculosis

Other conditions not listed may also increase a person’s risk of severe COVID-19. If unsure about their risk, people should talk with their doctor to see if they would benefit from a booster.

Dr. Brandi Freeman, a pediatrician at Children’s Hospital of Colorado and the associate vice chair for diversity, equity and inclusion at the University of Colorado Medicine, said individuals who frequently come into contact with others should also consider getting a booster.

This frequent exposure increases the chance that a person will contract the coronavirus, as well as pass the virus onto others if they themselves are infected.

Previously, the CDC approved boosters for people living in long-term care settings, as well as people who work as:

  • first responders, such as healthcare workers, firefighters, and police
  • long-term care staff
  • education staff, such as teachers, support staff and daycare workers
  • food and agriculture workers
  • manufacturing workers
  • corrections workers
  • postal workers
  • public transit workers
  • grocery store workers

“All of these people continue to put themselves out into a public area where it’s difficult to prevent the spread of [COVID-19],” Rizzo said.

Some of these workers, such as those at long-term care facilities, also come into contact with individuals who are at higher risk of severe COVID-19 — which is another reason for workers in those settings to consider getting a booster.

Other people not on this list who are around vulnerable or unvaccinated people may also want to get boosted.

This includes people caring for parents or other family members, including younger children.

“COVID-19 vaccination for 5- to 11-year-olds was just opened up, but there is the entire under-5 population that are not vaccinated,” Freeman said. “So people who are around them may want to consider getting a booster.”

Even with a wider rollout of COVID-19 boosters, Rizzo said the country still needs to get more unvaccinated people vaccinated.

Around 20 percent of Americans 12 and older have not had even a single dose, reports the CDC.

Although fully vaccinated individuals can end up in the hospital with COVID-19, unvaccinated people have a much higher risk.

This is putting strain on emergency departments and hospitals in some parts of the country, as COVID-19 hospitalizations increase.

“That not only puts the healthcare system in jeopardy,” Rizzo said, “but it also puts people who have non-COVID related illnesses who need hospital services — such as someone who had a heart attack — in jeopardy.”