COVID-19 Vaccine Boosters: The Latest Updates

Drug Topics JournalDrug Topics December 2021
Volume 165
Issue 12

Questions continue to swirl around eligibility for these shots.

As initial doses of COVID-19 vaccines made their way into the arms of millions of Americans, health experts and officials turned their thoughts toward the future—namely, toward COVID-19 booster shots. Across the public sphere has been intense debate about the idea of COVID-19 vaccine boosters.1

Some studies showed dwindling protection over time; other experts felt that booster shots simply weren’t necessary for those who had received a 2-dose vaccine series. Beyond the practicalities of vaccine efficacy, debates also raged about the ethical implications of providing additional protection to those living in wealthy countries while many in low- and middle-income countries had yet to receive even 1 dose.2,3

Ethical and effectiveness debates aside, the Biden administration announced in August1 a plan to provide COVID-19 booster shots to all Americans 8 months after their second Pfizer-BioNTech or Moderna dose. One month later, a government advisory panel “overwhelmingly rejected Biden’s plan,” backing boosters only

for older or high-risk individuals.4 In late October, the FDA took the first steps toward delivering boosters to these eligible populations, amending the earlier emergency use authorizations (EUAs) for all 3 COVID-19 vaccines.5

The FDA and CDC recommended booster administration as follows5,6:

  • Moderna, Pfizer-BioNTech: One single booster dose may be administered at least 6 months after completion of the initial series to adults 65 years and older and to adults aged 18 to 64 years who live in long-term care settings, have underlying medication conditions, or live or work in settings with a high risk of exposure to SARS-CoV-2.
  • Janssen (Johnson & Johnson): One single booster dose may be administered at least 2 months after completion of the initial single-dose regimen to adults 18 years and older. Both agencies also clarified that the COVID-19 booster vaccines are heterologous, allowing patients to mix-and-match based on preference and access.

On November 19, the FDA further amended each manufacturer’s EUA,7 expanding eligibility to all adults 18 and older who completed an initial vaccine series. Timing remains the same: those who received Moderna or Pfizer-BioNtech may receive a booster at least 6 months after initial vaccination, while those who received the Johnson & Johnson vaccine may receive a booster after 2 months.

The Pharmacist’s Role

For pharmacists concerned about getting booster shots into the arms of eligible patients, Celia Proctor, PharmD, MBA, assistant director for system formulary management and system integration for the Johns Hopkins Health System in Baltimore, Maryland, had some suggestions.

“One helpful direct messaging to past patients who were previously vaccinated by the clinic,” Proctor said. “Pharmacists can also provide education to patients who are hesitant or who have questions about the need for a booster dose.”

Patients who are hesitant to mix different brands of vaccine can be reminded that the FDA has authorized any of the COVID-19 vaccines to be used as a booster, regardless of which vaccine was received during the initial series, Proctor noted, adding that “education [can be] provided at the clinics as ‘just in time’ information to any patient who may have questions.”


  1. Perrone M, Stobbe M. US health officials call for booster shots against COVID-19. Associated P Newsress. August 18, 2021. Accessed November 15, 2021. 
  2. Burki T. Booster shots for COVID-19-—the debate continues. Lancet Infect Dis. 2021;21(10):1359-1360. doi:10.1016/S1473-3099(21)00574-0 . 
  3. Parker C, Pietsch B. Countries around the world are debating coronavirus booster shots. hHere’s where they’ve been approved. The Washington Post. November 12, 2021. Accessed November 15, 2021. 
  4. Miller Z. Top doctors say not so fast to Biden’s boosters-for-all plan. Associated P Newsress. September 18, 2021. Accessed November 15, 2021. 
  5. Coronavirus (COVID-19) update: FDA takes additional actions on the use of a booster dose for COVID-19 vaccine. News release. FDA. October 20, 2021. Accessed November 15, 2021. 
  6. CDC expands eligibility for COVID-19 booster shots. News release. CDC. October 21, 2021. Accessed November 15, 2021. 
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