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Are COVID-19 Vaccine Boosters Necessary?


All right, you've had your coronavirus vaccine. So you may be wondering, do I need to get another dose - a booster? Well, tomorrow an FDA advisory committee is expected to vote on whether to approve a booster dose of the Pfizer vaccine for anyone 16 years of age or older. But not everyone agrees that people even need boosters, and this debate is likely to get heated. Here to tell us why from NPR's science desk are Michaeleen Doucleff, Jason Beaubien and Will Stone.

Hey to all three of you.




CHANG: All right, so to help us understand what is at stake tomorrow, can you guys just tell us why it might be really contentious? Michaeleen, let's start with you.

DOUCLEFF: Well, the science isn't there. The vaccines are still working, and evidence indicates that most people don't need a booster.

BEAUBIEN: And, you know, much of the rest of the world is still waiting for shots. Less than 4% of Africans are fully vaccinated right now. It's just 1% for Nigerians.


BEAUBIEN: So for those countries, boosters look like this luxury of the rich.

STONE: But, Jason, things aren't great in the U.S. either. Hospitals are overwhelmed. The virus is raging. People are worried, and they want boosters.

CHANG: OK, so a lot of threads here to pursue. Michaeleen, I want to talk about the science first. Just to be clear, this is the drug company Pfizer that is asking the FDA to approve a third shot. What is the evidence on boosters right now? And haven't other countries started moving forward with boosters, at least in a limited way?

DOUCLEFF: Yeah, so scientists typically recommend a booster shot when there's convincing evidence that the vaccine doesn't offer enough protection. But several studies recently have shown that - the opposite with the COVID vaccines, that the vaccines are actually still working quite well, even against the delta variant. So, for instance, a study from the CDC found that the ability of the mRNA vaccines to stop a symptomatic infection has dropped a bit over time, but we're talking about a change from more than 90% effective to about 80% effective. And the vaccine's ability to stop severe diseases - so hospitalization and deaths - has hardly changed at all. It gives 90% protection across all age groups. And just this week, some of the FDA's own scientists wrote a review in The Lancet journal explaining how healthy adults right now don't need a booster.

CHANG: OK, so the vaccines are still working for healthy adults, but is that also true for older adults who may not be so healthy?

DOUCLEFF: Yeah, so here's where the evidence supporting boosters starts to grow and why some countries have ruled them out in limited populations. So several studies have shown that for older people, protection against severe disease is waning a bit over time, a small amount. So, for instance, a CDC study found with people over age 75, protection against hospitalization has dropped to about 75% compared to 90% for other adults. So many, many scientists I've talked to say that the data suggests boosters could be needed for more vulnerable people, people over 75 and those with high risks.

CHANG: What do you think, Will?

STONE: So the science may not be settled here, but the reality is that a lot of people in the U.S. still feel like they're at risk. The U.S. is in the middle of a huge surge - over 140,000 new infections every day. And in many places, it's wide open. People aren't wearing masks, and lots of people are unvaccinated. These are things people can't necessarily control, but getting a booster is.

DOUCLEFF: It's true, Will, but there's a difference - right? - between wanting a booster and needing a booster. Right? You know, you may want a booster to give a little extra protection against a mild or moderate illness, but that's different than needing a vaccine to survive.

CHANG: I do want to talk to you, Will, about that, these fears that you mentioned, because we know that some people are already getting boosters now, even though they aren't approved yet, right?

STONE: Yes, they are because breakthrough infections are becoming more common since the delta variant took off this summer. Now, granted, the risk of getting infected is much higher if you're unvaccinated. In the U.S., the risk of infection is five times higher for unvaccinated people compared to people who are vaccinated. But lots of Americans are doing a risk-benefit calculation, and they don't see the harm of another shot that might improve their chances of not getting sick. This includes doctors. Here's what Dr. Bob Wachter told me recently. He's at the University of California, San Francisco.

BOB WACHTER: Here I am. I'm a 63-year-old guy who got my two Pfizer shots about nine months ago. And if you told me I could run out to the Walgreens right now and get my booster, I would stop this interview (laughter), and I would go and do it.

STONE: Now, Wachter doesn't necessarily think everyone should do that. If you're a lot younger or had your shot in the spring, it's not clear that's a good idea. But in general, he says we should think about more than just whether or not you'll end up in the hospital. There's also the chance of getting quite sick, spreading it to others and possibly having long-term health problems, which is what we see with long COVID, even though we don't know the chances yet of that happening with a breakthrough.

CHANG: Jason?

BEAUBIEN: People in the U.S. are worrying about getting a booster because they think it'll keep them from getting a little sick, a mild infection, while people in much of the rest of the world are worrying about dying because they're not protected at all.

CHANG: Exactly. I mean, Jason, you covered global health. And can we just talk about the rest of the world?


CHANG: Because a lot of countries out there still haven't had their first round of vaccines, right?

BEAUBIEN: Right. And the WHO has been railing against this. This has been a huge issue for them. They are saying that there should be no boosters for healthy people until at least next year. You know, low-income countries have gotten less than 1% of all the doses given so far globally in this pandemic, and the WHO is really frustrated. You know, access to vaccines seems to be stacked against the poorer countries. There's still export bans blocking deliveries to them. You know, even after raising hundreds of millions of dollars to buy vaccines, the African Union this week says they can't purchase the doses they need right now on the open market.

CHANG: But the thing is, the Biden administration says the U.S. can do both right now. Like, they can not only give boosters here, but they can also help the rest of the world get vaccinated. How accurate do you think that is?

BEAUBIEN: Unfortunately, it's not accurate. It's wrong. I mean, they aren't doing both. The U.S. has given away millions of doses, but it's simply not enough. On a global level, there's a limited supply. There's only so much production coming out of these factories each week. And the question is, where are these doses most needed right now? You know, you look at Guatemala - just 10% of the population is fully vaccinated. Vietnam - it's less than 6%. And the WHO is saying those are the places where the world's vaccine supply should be heading right now, not for boosters for healthy people.

CHANG: OK. So, Will, I just want to go back to you now because, obviously, we're talking about this huge global need, and then there's also skepticism about the data supporting the need for boosters. Why are boosters still such a burning issue right now?

STONE: Well, remember; the White House and trusted figures like Dr. Anthony Fauci came out strongly for boosters. They made the case it's necessary and set those expectations. For many people who already had their shots, that's enough. It doesn't necessarily matter that this all happened before the FDA and the scientific community had come to any kind of consensus.

DOUCLEFF: And, Ailsa, let's not forget that Pfizer and the other vaccine companies are making a huge amount of money off these vaccines. Pfizer expects to sell something like $33.5 billion worth of COVID vaccines this year, and a wide rollout of these boosters could drive that figure even higher.

CHANG: That was NPR's Michaeleen Doucleff, Will Stone and Jason Beaubien.

Thanks to all three of you.

DOUCLEFF: Thank you.

STONE: Thanks.

BEAUBIEN: You're welcome. Transcript provided by NPR, Copyright NPR.

Michaeleen Doucleff, PhD, is a correspondent for NPR's Science Desk. For nearly a decade, she has been reporting for the radio and the web for NPR's global health outlet, Goats and Soda. Doucleff focuses on disease outbreaks, cross-cultural parenting, and women and children's health.
Jason Beaubien is NPR's Global Health and Development Correspondent on the Science Desk.
Will Stone
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