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At the beginning of the vaccine rollout, the guidance was simple: Get whichever shot you can as soon as it's available to you. But now that mixing and matching vaccines has been approved by the U.S. Food and Drug Administration (FDA), many of us are wondering if we should try a different shot for our COVID booster. As of now, the FDA's acting commissioner Janet Woodcock, MD, has said that the agency is not recommending one vaccine over another, The New York Times reports. And the Moderna and Johnson&Johnson booster shots still have to be officially approved by the Centers for Disease Control and Prevention (CDC) before they can be rolled out, so you have some time to decide. But if you're feeling uncertain, White House COVID adviser Anthony Fauci, MD, has some useful advice to put things in perspective.
In an Oct. 21 interview with CBS, the National Institute of Allergy and Infectious Diseases (NIAID) director made it clear that while the vaccines remain very protective against COVID infection—particularly when it comes to more severe outcomes like hospitalization and death—those who want "optimal" protection from the virus, should get a booster if they're eligible, per CNN.
"The vaccines from the original regimen that we got [are] still holding really quite well when it comes to protection against severe disease and hospitalization," Fauci told Gayle King. "Even though people right now who've been vaccinated within the last several months can feel comfortable, if you really want to have the optimal protection, Gayle, then the people who are qualified and eligible to get the booster should do it."
When it comes to which booster to get, however, Fauci was a bit cagier. King specifically asked about Johnson&Johnson recipients, who might be considering a Pfizer or Moderna booster instead of a second shot of their original vaccine. After all, one recent study, preprinted Oct. 13 on medRxiv, found that those who got Johnson&Johnson received much higher antibody levels from boosters of the mRNA vaccines. While a second Johnson&Johnson shot boosted their antibody levels four-fold, these recipients saw a 35-fold rise from Pfizer and a 76-fold rise from Moderna.
Much like the experts at the FDA, Fauci is not ready to say one way or another which booster you should get. Instead, he said there are three important things to do—determine your personal preference, talk to your doctor, and do a risk assessment based on considerations like your age and gender.
For example, a person who got Johnson&Johnson who wants the most protection possible might decide to wait for a Moderna shot based on the latest research. If that person is a young man, however, they could opt to stick with Johnson&Johnson, which has not been associated with the rare side effect of myocarditis. Though extremely unlikely as a vaccine reaction, myocarditis—a type of heart inflammation—has been seen "after mRNA COVID-19 vaccination (Pfizer-BioNTech or Moderna), especially in male adolescents and young adults," according to the CDC.
"The risks for adverse events, Gayle, are really very, very rare and very, very low," Fauci told King. "But in a certain situation, for example, if I were a woman, I would probably not have any problem at all with an mRNA because the rare, rare adverse event with the mRNA is almost exclusively seen in young men. So, you really have to balance what the risk benefit is. But, I want to emphasize that the risk of adverse events is really very, very low."
All three of the COVID boosters have been proven to be safe and effective, so there's no real wrong choice. Figuring out which booster to get if you're eligible is ultimately an individual decision, and for the time being, health officials are not expressing a preference one way or the other. But if you follow Fauci's advice and do a personal risk assessment while consulting with your doctor, you'll at least know you've made an educated choice.