- Health officials in Europe are expanding vaccine guidelines to include more at-risk populations, including the elderly and those with underlying conditions, to be eligible for a fourth COVID-19 booster shot.
- In the U.S., federal health groups have already approved a fourth vaccine dose for immunocompromised Americans and may consider other subsets of the population sooner than expected.
- New research indicates that current vaccines and booster schedules may not provide optimal protection against COVID-19 infection, but top infectious disease experts say that severe side effects, hospitalization and death are still largely prevented.
- Recent public statements made by Pfizer and Moderna executives indicate that a fourth dose may be made available to the general public later this year, in the fall.
Health officials in the United States are preparing to release updated COVID-19 guidelines as contagious Omicron rates continue to fall, according to Reuters’ reports — and Americans may be wondering if news about a fourth vaccine is soon to follow.
Public health agents in Sweden made official recommendations earlier this month for residents over 80 years old to receive a second booster dose of a COVID-19 vaccine, a fourth dose overall, as more evidence suggests those particularly at high-risk for complications may need it sooner. Shortly after, top public health official Anthony Fauci, M.D., highlighted new data generated by researchers at the Centers for Disease Control and Prevention (CDC) which suggested top-tier protection provided by a third-dose booster may start to decline after just four months.
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“There may be the need for yet again another boost — in this case, a fourth-dose boost for an individual receiving the mRNA [vaccine] — that could be based on age, as well as underlying conditions,” Dr. Fauci told the media in early February.
The need for a fourth vaccine dose before the winter is out could be debated by diseased experts, however, as data still shows current vaccine timelines are largely effective against serious illness. CDC data indicated that while third doses were effective 91% of the time against COVID-19 hospitalizations within the first two months, efficacy slipped slightly to 78% by the end of month four. The study also did not account for age ranges or pay special care to exclude immunocompromised Americans when considering conclusions, two groups that are directly indicated in high-risk categories.
And others are worried that another booster shot in a similar frequency may end up leading to an underwhelming weakened immune response, a complex topic known to scientists as original antigenic sin, according to Shira Doron, M.D., an infectious disease physician and epidemiologist at Boston’s Tufts Medical Center. It’s unclear if booster timing will truly end up being an issue for COVID-19 vaccines at this stage, but a press briefing held overseas by the European Medicines Agency (EMA) touched upon the potential downside of having COVID-19 booster doses administered too closely together.
If anything is clear, it’s that more nations are considering updating vaccine guidelines to include additional doses for at-risk populations, as highlighted by the New York Times. Current CDC guidelines encourage a certain subset of Americans to seek out a fourth dose now based on their medical history, and more subsets of at-risk people may be considered in the future. If you’re curious about when it may be time for another COVID-19 vaccine, we’ve polled infectious disease experts like Dr. Doron to answer questions about a potential timeline for additional doses as federal officials prepare for the next stage of the pandemic.
As more information about the coronavirus pandemic develops, some of the information in this story may have changed since it was last updated. For the most up-to-date information on COVID-19, please visit online resources provided by the CDC, WHO, and your local public health department.
When can I get a fourth COVID-19 vaccine?
As of now, nearly all health authorities agree — it is too soon to determine when a fourth dose may be recommended to a broader proportion of the American public. If you have a rather straightforward health history (not considered at elevated risk for serious complications from a COVID-19 infection), you shouldn’t be concerned about seeking out another booster shot anytime soon due to vaccines’ current efficacy against severe COVID-19 infection.
Dr. Doron explains that current goals set forth by CDC officials and officers at the Food and Drug Administration (FDA) may shift to focus exclusively on preventing severe disease and hospitalization due to COVID-19 — as opposed to infection overall — as more variants like Omicron present themselves in the future. “If the goal is to prevent severe disease, then many Americans may not need another dose for years — we will have to see,” she adds.
Pei-Yong Shi, M.D., a molecular biology professor at the University of Texas Medical Branch currently leading clinical COVID-19 vaccine research, says that more data will be needed to suggest a fourth dose for the entire general population. “We still don’t know the durability of the neutralization after the third dose,” Dr. Shi adds. “Studies are ongoing to monitor the durability of the neutralization and real-world vaccine effectiveness in the clinics.”
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It’s more likely that elderly Americans and those with pre-existing conditions that impact immunity may potentially see an update to vaccine guidance in the near future. Dr. Doron says that if health officials decide to solely target severe disease rates versus total infection rates, “then a fourth dose is not likely to be necessary or recommended for all Americans, but would be more likely to be indicated for those who are older, or otherwise at higher risk for hospitalization and death.”
Another shift in vaccine guidance isn’t entirely out of the question, though, as CDC officials have previously demonstrated this when updating recommendations to allow third-dose Pfizer boosters at the five-month interval instead of six. But experts are also continually overhauling COVID-19 vaccine production in response to variants like a new ‘stealth’ Omicron, and the focus could be on tweaking current vaccines for even more resilient immunity in the future. New options like the high-profile nasally administered COVID-19 vaccine may not be too far off.
“It’s crucial that there be continued research and development on new vaccine technology. We could benefit greatly from vaccines with greater durability, and that are more variant proof,” Dr. Doron explains. “In the meantime, for those who are unvaccinated, the CDC’s Advisory Committee on Immunization Practices is considering changing the interval between the first and second dose of mRNA vaccine, which we now know increases both safety and efficacy.”
Do I need a fourth COVID-19 vaccine?
It’s important to remember that while vaccine efficacy against infection may degrade as time goes on, all health experts have noted that vaccines are still crucial for preventing severe illness, hospitalization and death. “Vaccines and boosters have proven incredibly effective, and offer the highest level of protection,” Dr. Fauci said in the same press briefing in early February. “250 million Americans have stepped up to protect themselves, their families, and their communities by getting at least one shot — and we have saved more than one million American lives as a result.”
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The focus for health officials remains on encouraging unvaccinated Americans to seek out their initial COVID-19 vaccine. Dr. Fauci took time to clarify that it’s almost entirely likely that fourth doses will first be considered for those who “have a diminished… protection against the important parameters, such as hospitalization.”
Practicing best habits when it comes to COVID-19 prevention — wearing a mask in crowded public spaces, choosing well-ventilated areas to meet with family or friends — and ensuring you are up-to-date on your COVID-19 vaccination will likely keep you healthy this winter. While it’s still up in the air, according to experts, most signs point to a fourth dose becoming a reality later this fall.
Trials at Pfizer and Moderna are well underway to create COVID-19 vaccines that specifically target Omicron, per U.S. News & World Report. And a public appearance by Moderna CEO Stephane Bancel indicated early plans that the company has for these vaccines. “We are discussing with public health leaders around the world to decide what we think is the best strategy for the potential booster for the fall of 2022,” he told CNBC. “We believe it will contain Omicron.”
Those who are considered at very high-risk, the immunocompromised population, have been eligible to receive a fourth dose of the COVID-19 vaccine for several months — and may need a subsequent fifth shot in the future.
Who is considered immunocompromised for a fourth dose?
If you’re considered immunocompromised due to an underlying health condition or current treatment, your healthcare provider has likely already updated you to a shift in vaccine guidelines set forth by the CDC. Back in August 2021, an initial booster dose was authorized for immunocompromised individuals — but soon made it clear that this third dose would be considered part of the primary vaccination series due to these individuals’ impaired immune response to the first two-shot series.
In October, CDC officials authorized a fourth booster dose for immunocompromised Americans to stem COVID-19 infection risk, as long as it had been at least six months since their last shot. That guidance changed when the Omicron wave proved to be highly infectious over the holiday season and in January, as it continues to be the dominant variant in COVID-19 spread currently. Recently, CDC officials shortened that interval to five months, meaning those who received their third Pfizer COVID-19 vaccine dose back in August are now eligible to get a fourth shot this winter.
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“People who are severely immunocompromised may not mount an adequate response, or any response at all, to two doses, but studies show that a third dose elicits an antibody response in a subset of those patients — which is why the primary series of mRNA vaccines for them is three doses,” Dr. Doron explains. “Like everyone else, they are then eligible for a booster when immunity wanes.”
As many as 3% (or 7 million) adults in the U.S. are considered immunocompromised by health officials. Previously, FDA officials have shared the kinds of conditions that would qualify someone for additional COVID-19 shots, with cancer patients and organ transplant recipients at the forefront of this category. There are more than 200 specific immune deficiency diseases that can lead to a clinical immunocompromised status, per the National Institute of Allergy and Infectious Diseases. Some common conditions for immunocompromised individuals include:
- Blood disorders, such as leukemia and lymphoma
- Cancer patients in treatment currently
- HIV/AIDS
- Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis
- Lupus
- Multiple sclerosis
- Rheumatoid arthritis
- Type 1 diabetes
It’s crucial for immunocompromised individuals to inquire about boosters with their healthcare providers, as data suggests a singular COVID-19 vaccine as well as an infection don’t produce enough antibodies to prevent future sickness. And COVID-19 illnesses are much more intense and severe for these individuals, with death rates in this subset currently over 50%, according to the Times.
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