In China, COVID-19 vaccination is required for everyone and sometimes force and coercion are used. In the United States, vaccines are never required. No one is forced to get vaccinated, although consequences have been imposed; for instance, the unvaccinated have been refused employment for certain jobs and not allowed to attend public schools. The CDC makes recommendations, and it is left up to individuals whether they choose to follow the recommendations. Since COVID-19 struck, individuals have had to make a lot of decisions. Should I get vaccinated? If so, which vaccine? Should I eat out in restaurants? Should I wear a mask? Should I avoid crowds? When should I social distance? Should I get my children vaccinated? Should I get a booster shot? If I am eligible, should I get a second booster?

My sister happened to be on a flight at the moment when the mask requirement for air travel was lifted. When the pilot made the announcement, everyone took off their masks and cheered. My sister and many other passengers promptly put their masks back on. Rather than resent masks as a violation of their freedom, they realized masks were a proven public health measure to protect themselves and others. The pandemic is far from over. In the past two weeks, there has been a 57 percent increase in cases and a 29 percent increase in hospitalizations. Over a million people have died of COVID-19 in the United States, and 300 are still dying every day. If everyone had followed public health guidelines, many of those deaths could have been prevented.

Who is eligible for a second booster?

The rules are clear but complicated enough that they may be difficult for some to interpret.

You are eligible for a second booster if you:

• Are fifty years of age or older and got your first booster at least four months ago;
• Are twelve years of age or older and are moderately or severely immunocompromised and got your first booster at least four months ago;
• Are eighteen years of age or older and got two doses of the Johnson and Johnson vaccine at least four months ago;

Remember that second boosters can only be Moderna or Pfizer-BioNTech (and for people ages twelve to seventeen, only Pfizer-BioNTech.)

Another thing to consider: Are you or someone you live with more likely to get very sick from COVID-19 or more likely to be exposed to the virus? Are you or they:

• Moderately or severely immunocompromised?
• More likely to be exposed through your job, where you live, frequent travel, or large gatherings?
• In an area with medium to high COVID-19 community levels?
• Living with someone who is unvaccinated?

If any of these factors apply, it may be more important to get that second booster now.

Understanding the Data

Because individuals will be making their own decisions, it’s important that they understand the facts. Numerous studies have shed light on the facts, but there’s still a lot we don’t know. Research is ongoing and new results will continue to be reported. Here are some of the many recent results:

• The Omicron variant is highly contagious. This December 2021 study found that antibody titers to the variant were low or undetectable after two immunizations with the Pfizer vaccine and in most convalescent sera from unvaccinated individuals infected by different variants. A booster significantly increased antibody titers to levels comparable to those seen after two Pfizer doses for the earlier strain.
• A May 2022 study published in the New England Journal was a placebo-controlled, randomized phase 3 trial comparing a booster dose of the Pfizer vaccine to a placebo. Results: “Covid-19 with onset at least 7 days after dose 3 was observed in 6 participants in the vaccine group and in 123 participants in the placebo group, which corresponded to a relative vaccine efficacy of 95.3% (95% confidence interval, 89.5 to 98.3).”
• Another study, also published in The New England Journal of Medicine in May2022, found that a fourth (second booster) dose of the Pfizer vaccine given to Israelis sixty years of age and older during an omicron outbreak resulted in better protection than the three-dose regimen alone. 1.5 cases of severe COVID-19 per 100,000 person-days for 4 doses vs. 3.9 for 3 doses. Severe illness was lower by a factor of 3.5 for 4 doses vs. 3, and protection did not wane during the six weeks after the booster, although protection against confirmed infection appeared short-lived.
• Another study in Israel confirmed the effectiveness of a fourth dose, with the absolute risk of hospitalization dropping by 180.1 cases per 100,000 and the absolute risk of severe COVID-19  dropping by 68.8 cases per 100,000.
• Two matched retrospective cohort studies in Qatar found that third doses (first boosters) of both the Pfizer and the Moderna vaccines were highly effective against symptomatic infection with the delta strain but less effective against the omicron strain. For the Pfizer vaccine, the booster dose was 86.1 percent effective compared to the primary series for delta and 49.4 percent effective for omicron; for the Moderna vaccine, booster effectiveness for omicron was 47.3 percent compared to the primary series. Pfizer booster effectiveness against omicron-related hospitalization and death compared to the primary series was 76.5 percent.

I answered YES

My husband and I are both over fifty, and we recently got our second booster shots to minimize our risk. He had a mildly sore arm. I had a fever and felt weak and achy but only for one day; I consider that a small price to pay for the extra insurance. No regrets. If another booster is recommended in the future, I will get it.