Get a Different Booster If You Got This Vaccine, Virus Experts Say
You may be more protected by going with another COVID vaccine next time.
After weeks of deliberations between advisory committees and agencies, booster shots from Pfizer, Moderna, and Johnson & Johnson have finally been authorized in the U.S. The millions of people now eligible for additional doses are likely weighing their options, after both the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) also chose to authorize a mix-and-match approach, in which recipients are free to choose from any of the three boosters, no matter which vaccine they got initially. Health officials are not currently recommending one booster over another, as CDC Director Rochelle Walensky, MD, said that the agency "will not articulate a preference." But some virus experts are comfortable sharing their opinions on the matter.
Jyotsna Shah, PhD, virus expert and president of IGeneX Laboratory, told Best Life that she advises Johnson & Johnson recipients to get a booster from one of the other two vaccines. Under the FDA and CDC's authorization, all Johnson & Johnson recipients who are at least two months out from their initial shot can get a booster.
"For those who initially received the Johnson & Johnson vaccine, I would recommend seeking out the Moderna or Pfizer booster," Shah says. "Firstly, because it seems that the Johnson & Johnson vaccine's efficacy has waned faster than either Moderna or Pfizer. Secondly, because there is evidence to show that mixing vaccine types can be highly effective."
Recent data from a National Institutes of Health (NIH) and the National Institute of Allergy and Infectious Diseases (NIAID) study found that those who initially got the Johnson & Johnson vaccine were significantly better off after getting a different booster. When getting a Moderna booster, Johnson & Johnson recipients had their neutralizing antibody levels rise 76-fold within 15 days, while a Pfizer booster raised their antibody levels 35-fold. In comparison, a Johnson & Johnson booster only increased the levels 4-fold.
"Because the Johnson & Johnson vaccine and vaccines like Moderna and Pfizer are different types of vaccines, you're essentially giving your body more tools to fight the virus," Shah explains.
Vino Palli, MD, chief executive officer of MiDoctor Urgent Care in New York, adds that immunocompromised individuals who received Johnson & Johnson in particular may want to seek out an mRNA booster instead, as research has shown that people with compromised immune systems are significantly less protected from all three of the vaccines than other individuals.
On the other hand, some experts say it does not matter which vaccine you choose for your booster shot. "It's generally recommended that you get the booster that is the original regimen that you got in the first place. But, for one reason or other, and they may be different circumstances for people, availability or just different personal choices, you can, as we say, mix and match," White House COVID adviser Anthony Fauci, MD, said Oct. 22 on CNN's New Day Friday.
Getting a second shot of Johnson & Johnson does appear to elicit a strong immune response as well. According to data from the company, its booster dose can increase protection against symptomatic infection from 72 percent to 94 percent among those who initially received Johnson & Johnson's one-shot vaccine when given two months later.
Following the release of the NIH study, Johnson & Johnson doubled down on the effectiveness of its booster vaccine, stating that the study merely demonstrates that a supplementary shot of its vaccine "increases immune response regardless of a person's primary vaccination," per NPR.
But your personal risk of adverse reactions may also play a part in your decision on which booster to get. Women under the age of 50 might want to consider choosing an mRNA booster instead of Johnson & Johnson, even if they initially got the one-dose vaccine, because they are more at risk for a rare, but severe blood clotting disorder after receiving the Johnson & Johnson vaccine.
Younger men, on the other hand, may want to do the opposite. A study published Oct. 6 in the New England Journal of Medicine found that men aged 16 to 29 are significantly more at risk for two types of heart inflammation, myocarditis and pericarditis, after receiving either mRNA vaccine. And although the risk is still very small, those falling into this group might feel safer getting a Johnson & Johnson booster.
"For patients that had adverse reactions after their initial shots, certainly it would be reasonable to seek out a different vaccine for their booster," says Vivek Cherian, MD, an internal medicine physician at Amita Health in Illinois. "If you fell into the rare statistic of developing a blood clot after receiving the Johnson & Johnson vaccine, you wouldn't obviously want to get the booster. If you are a woman you likely would not have any issues at all with an mRNA vaccine because the exceedingly rare adverse events with mRNA vaccines are seen almost exclusively in men."