COVID-19 booster shots: What we know about a fourth vaccine dose

Could we need four vaccine shots to combat omicron?
Sarah Tew/CNET

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More than 100 million people in the US are eligible for a COVID-19 booster shot from Pfizer or Moderna, and new groups (including 16 and 17 year olds) are authorized for a third dose. With early reports that the rapidly spreading omicron variant might be able to more easily break through some vaccine protection compared to delta, a new question has emerged: Will a fourth dose of the COVID-19 vaccine be necessary for full protection as the effects of the booster shot wane? “I think we will need the fourth dose,” Pfizer Chairman Albert Bourla said on CNBC on Wednesday. “I was projecting that that will be in 12 months after the third dose. With omicron,” he said, “we may need it faster.”Since omicron was detected in South Africa at the end of November, the mutated virus has spread to at least 60 countries and 22 US states. Scientists are rushing to gather information on the COVID-19 variant, including how easily it can pass between people (it’s thought to be highly contagious), how serious an infection it can cause and if it can evade immunity, either from a previous infection or through a vaccine. It could be weeks, however, before conclusive data and test results are ready. The COVID-19 vaccines have so far proven to be highly effective in preventing hospitalization and serious illness. People who are unvaccinated are 10 times more likely to be hospitalized if infected. Early lab tests suggest booster shots could help protect against the omicron virus mutation, too. Here’s what we know about another booster shot from Pfizer, Moderna or Johnsons & Johnson. Here’s also what we know about “free” at-home COVID-19 test kits, stricter travel rules for international travelers and evolving vaccine mandates.

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Why would I need a fourth vaccine dose? Isn’t one booster shot enough?With omicron, the talk of another COVID booster has been pushed to the front of the line.By the second week of December, more than 200 million in the US were fully vaccinated for the COVID virus (with either two doses of the Moderna or Pfizer vaccine or one dose of Johnson & Johnson’s), and nearly 49 million had received a booster shot. Even before the omicron variant emerged, disease experts were already considering the need for an annual COVID vaccine booster to top off protection as the effectiveness of the vaccine wanes. “There are vaccines like polio that one dose is enough,” Pfizer’s Bourla said back in April, as the COVID vaccines were becoming widely available in the US. “And there are vaccines like flu that you need every year. The COVID-19 virus looks more like the influenza virus than the polio virus.”Do some people already qualify for a fourth dose of the COVID vaccine?Some countries are looking at authorizing a second booster shot for certain individuals. Israel, for example, is considering a fourth shot of the COVID vaccine for people who are immunocompromised. The Food and Drug Administration and the Centers for Disease Control and Prevention could authorize a fourth shot in 2022 for a similar group in the US.

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Would everyone be eligible for a fourth COVID vaccine dose?Right now, scientists are examining early test samples to determine how effective the current vaccines are, whether a variant-specific vaccine is needed to protect against omicron and other future variants, and who would qualify for yet another booster shot. Preliminary data suggests that the omicron variant may be able to evade immunity caused either by previous infection or through a full vaccine course.The omicron variant is changing the definition of full vaccine protection, said Ugur Sahin, CEO of BioNTech, which made the vaccine in partnership with Pfizer, on Wednesday. “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,” Sahin said. If three doses of the Pfizer COVID vaccine are needed to protect against the omicron variant, the timeline for a fourth shot could be pushed up, as early 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 on Wednesday.So is Pfizer/BioNTech creating a new booster shot for omicron?Executives for Pfizer and BioNTech said their companies are gathering data on the effectiveness of its current vaccine against the new variant and in parallel developing an omicron-specific vaccine in case it’s needed. The variant-based vaccine could be ready by March 2022, pending regulatory approval. The vaccine-makers said they are also looking at a multivariate vaccine that could protect against other strains, such alpha (the original COVID-19 strain detected) and delta.Masks and vaccines can check COVID’s spread.
Sarah Tew/CNET
What has Moderna said about another booster shot to protect against the omicron variant?Like Pfizer, Moderna said it’s testing the effectiveness of its COVID-19 vaccine against omicron, and said it may be weeks before it knows how well its current vaccine protects against the new variant. The company has offered little specific information on its own vaccine so far. It has set out it’s approach to the variant. Including examining the effectiveness  of a 100-microgram dose of its booster against the omicron variant. It’s current booster is a 50-microgram dose.If Moderna needs to develop a new vaccine specifically for the variant, the company said, it could be available early in 2022.CNET reached out to Moderna for more on its vaccine development and omicron but didn’t immediately get a response.What has Johnson & Johnson said about a second booster shot of its vaccine? Johnson & Johnson has also been quieter on the effectiveness of its own vaccine and said it’s begun work on a new vaccine designed for omicron and is working with scientists in South Africa and around the world to evaluate the effectiveness of its current COVID-19 vaccine against the omicron variant.CNET reached out to Johnson & Johnson for more on its vaccine development and omicron but didn’t immediately get a response.For more on COVID, here’s how the new omicron variant is different from delta, 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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