What you need to know as COVID booster eligibility expands in state

Millions more Americans became eligible Friday for COVID-19 booster vaccinations after a move this week by the Centers for Disease Control to significantly widen access.

Now, for the first time, recipients of all three approved COVID vaccines are eligible to get a booster.

CDC Director Rochelle Walensky said the expansion is “another example of our fundamental commitment to protect as many people as possible from COVID-19.”

Who is eligible? What are the limitations? Here are answers to your COVID-19 booster shot questions:

Can I get a booster?

The CDC said this week that anyone 65 and older who received a Pfizer-BioNTech or Moderna COVID-19 vaccine is eligible for a booster shot six months after the completion of the initial two-shot course.

In addition, people 18 and older who live in long-term care or high-risk settings, or who suffer from underlying medical conditions, are also eligible to get a vaccine booster.

For recipients of Johnson & Johnson’s COVID-19 vaccine, the CDC said booster shots are recommended “for those who are 18 and older and who were vaccinated two or more months ago.”

What are the qualifying medical conditions?

The list of accepted medical conditions includes patients suffering from cancer, chronic kidney, lung and liver disease, dementia or other neurological conditions, both type 1 and 2 diabetes, Down syndrome, HIV, heart conditions, have sickle cell disease or thalassemia, have had a stroke or cerebrovascular disease or tuberculosis.

Smokers are eligible, as are pregnant women, patients struggling with substance abuse or mood disorders, including depression, and patients who have had a solid organ or blood stem cell transplant.

The CDC also recommends that people who are overweight get a booster shot, defined as a body mass index greater than 25 kg/m2. “The risk of severe COVID-19 illness increases sharply with elevated BMI,” the CDC said.

“There’s a ton of permutations,” Ohm Deshpande, who is in charge of vaccine administration for Yale New Haven Health, said during a press conference this week. “It is pretty easy for someone to fit themselves into that category, I think. It’s not all comers, but it is pretty broad.”

What settings are considered high-risk?

All first responders (including health care workers, firefighters, police and staff of congregate care facilities) are considered to be at highrisk of infection.

In addition, people who work in education staff (teachers, support staff and day care workers) are considered high-risk, as are food and agriculture workers, manufacturing workers, corrections workers, people who work for the U.S. Postal Service, public transit workers and grocery store employees.

Can vaccines be mixed and matched?

Yes, CDC recommendations now allow for “mixand-match dosing for booster shots.”

“Eligible individuals may choose which vaccine they receive as a booster dose,” the CDC said. “Some people may have a preference for the vaccine type that they originally received and others, may prefer to get a different booster.”

One study, Deshpande said, showed that for people who received the Johnson & Johnson vaccine, the level of “antibody response” was “considerably higher” if they received a booster of either Moderna or Pfizer’s vaccine.

“It does look like mixing mRNA vaccines with J&J is likely to be more effective, but the proof is in the pudding,” he said.

Is there a difference between a third shot and a booster?

Deshpande said that while the two terms are often used interchangeably, a third dose is usually administered to a patient who has been immunocompromised.

“For folks who are immunocompromised, their immune systems aren't strong enough to generate the immunity response,” he said. “They don't have so much of an immune response to boost.”

That third dose is often administered two weeks after the second.

Other patients, whose immunity to the virus has waned over time, would get a booster.

“There's some thought that the immunity wanes,” Desphande said. “The idea is, you get another shot, a booster, to boost that immunity.”