Choose Your Own Adventure Boosters

The CDC is leaving it up to you!

In something of a counterpoint to my previous post arguing that amateurs shouldn’t try to second-guess experts on COVID treatments, the Atlantic’s Katherine J. Wu observes that “No One Will Stop You From Getting Whatever Booster You Want.”

Mixing and matching vaccine brands is officially on the table in the United States. But that option might soon be billed as the B-list choice.

[On October 21], CDC Director Rochelle Walensky gave the green light for Moderna and Johnson & Johnson booster shots, the long-awaited follow-up to a similar recommendation given to the Pfizer formulation last month. As the endorsement stands, all who are eligible for an additional jab—which now includes tens of millions more Americans—should be able to pick whatever booster brand they like. But discussions among a panel of experts who advised Walensky hinted at a catch: The agency has yet to issue its final clinical guidance on who, specifically, might want to boost with what—and an early draft of the recommendations suggests that Americans “should” stick with the same brand they got in their first go-round.

Switching to a different shot would be allowed, as was authorized by the FDA on Wednesday; per the draft CDC guidance, people may opt to mix and match based on availability or preference, after assessing their individual risks and benefits. (As a reminder, the FDA’s authorizations tell Americans what vaccines they’re allowed to get. The CDC follows that up with advice on what folks should do with those options.)

The CDC’s stance on mixing and matching, then, could end up being a relatively soft one, neither extolment nor excoriation. That might also be the most practical course of action for the agency, given the variables involved and the lack of clear-cut evidence that could untangle them. But the wishy-washiness of Pick whatever is confusing as hell.

Wu goes into the pros and cons of sticking versus switching and then concludes,

Even in the U.S., getting more first shots to people remains the bigger priority—that’s how we collectively contain the coronavirus. But the hyper-individualistic American approach to the pandemic is once again nudging each of us to chart our own course. The government has kind of shrugged about mix-and-match boosting, and punted the decision to us: Choose whichever path seems right to you; turn to page 7; hope for the best. Here’s the trick, though—no one’s sure where this chapter ends. Good luck, I guess.

This may simply be a case where all of the available options are really safe and effective and simply getting boosted is more important than which booster. But, aside from being confusing as hell, it also effectively encourages people to become faux experts.

My plan is to get boosted next week, when I can afford to miss a day of work if the side effects are worse than they were for my second dose. I’ll almost certainly stick with Moderna because, well, why not. But it’s weird that the experts are leaving it up to me to decide rather than giving their best recommendation.

FILED UNDER: COVID-19, Health
James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. OzarkHillbilly says:

    But it’s weird that the experts are leaving it up to me to decide rather than giving their best recommendation.

    Their best recommendation is to get a booster, and it doesn’t matter which one you get. Not weird at all to me.

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  2. Jen says:

    I’m too busy to bother to shop around–what will dictate my booster is whatever is available at the Walgreens where I got shots 1 & 2. I’m scheduled for today.

    What I’ve found interesting are the anecdotal reports from friends who are having side effects with the booster that they didn’t have with shots 1 or 2. My 85 year-old father had the same strong effects from his Moderna booster that he had with 1 and 2–but he frequently does have side effects to vaccinations (he always feels sluggish and ill after his annual flu shot, for example).

    On the issue of the CDC’s stance–I’m not surprised. They are, perhaps wisely, picking their battles and the type of booster for vaccine enthusiasts is probably not a priority.

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  3. Scott says:

    This may simply be a case where all of the available options are really safe and effective and simply getting boosted is more important than which booster.

    My plan is to get boosted next week, when I can afford to miss a day of work if the side effects are worse than they were for my second dose.

    Bottom line is that it really doesn’t matter that much which booster is used. The external individual physical effects are much greater the internal immunization responses. I already got my Moderna booster on the 22nd, and, as is typical with me with almost all vaccines, I had no discernable reaction at all.

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  4. CSK says:

    From my personal experience: I got the J&J at Mass. General Hospital last March because that was what they were doling out that day. When I asked my doctor which booster I should get, she replied, “Whichever is available.” Last Wednesday I received the Pfizer. The annual flu, I got in September at my check-up.

    Don’t hate me, but there were no side effects from any of them. Oddly, like Jen‘s father, flu shots once made me sluggish the following day. Oddly, they haven’t for quite some time.

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  5. Tony W says:

    We studied the various options and learned that the Moderna vaccine has the best outcomes, so we opted for that. Similarly, when paired with the Moderna booster it appears to continue to be the most effective by a tiny margin.

    Easy choice for us.

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  6. Tony W says:

    @Jen: Got the Moderna booster yesterday – side effects, so far, seem to be in between the almost-zero side effects of shot #1, and the “down for a day” effects of #2.

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  7. JohnMcC says:

    Got Moderna boost to Pfizer vax and got flu shot the same day. Had no side effects except sore shoulders.

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  8. gVOR08 says:

    I mentioned a couple days ago that I got Moderna shots and when I made my appointment online for a booster CVS defaulted to Moderna without offering any option. Fine with me. And I should probably footnote that the evening before their website wasn’t working at all, so what I saw may have been website fix version X, and X+1 may be different.

  9. inhumans99 says:

    Dr. Joyner you said: “But, aside from being confusing as hell, it also effectively encourages people to become faux experts.”

    Isn’t that already the case with Covid?

    I remember reports of Senator Rand Paul arguing with Dr. Fauci, and many members of the GOP cheering him on when they thought he scored a point against Dr. Fauci. Also, DeSantis is against “Fauciing” his state, so we know he has already declared himself an expert on all things Covid.

    In other words, asking folks to listen to a small number of incredibly learned individuals about all things Covid is a ship that has long since sailed. This is the horse that has left the barn, been to Paris, had a dalliance or two with a sweet young filly, and enough time has passed that the filly is now the baby mama for one or two foals connected to the tryst with this horse.

    Of course, you already know this.

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  10. Michael Reynolds says:

    I’m getting my Moderna booster tomorrow. Why Moderna? Because all the cool kids choose Moderna. I mean, J&J? That’s the TJ Maxx of boosters. Pfizer’s fine, but it’s everywhere, you know? There’s no sense of exclusivity. It’s, sigh, middle class. Put it this way, can you see a Pfizer boutique on Rodeo Drive? No. It would have to be Moderna sandwiched in between the Fendi shop and the Gucci shop.

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  11. CSK says:

    @Michael Reynolds:
    I like T. J. Maxx. And I got a Pfizer booster. I must be hopelessly bourgeois.

    Sudden memory: When I was about 13, and someone asked me to do something routine, I’d reply: “That’s bourgeois and conventional.” Christ, I must have been a pain in the ass sometimes.

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  12. Crusty Dem says:

    Why mix and match? Why not? There’s no clear clinical data on the cost/benefit of mixing and every bit of evidence from antibody titers suggest it’s superior to any given single type..

  13. Michael Reynolds says:

    @CSK:

    Christ, I must have been a pain in the ass sometimes.

    I’ve mentioned before that I have an intelligent and relentless 24 year-old daughter who regularly drives me crazy. Then I access memory. I look at myself at that age, and. . . oy. Especially my father, an Army lifer, warrant officer, two tours in Vietnam, having to listen to my cocky, sanctimonious bullshit? It’s a miracle the man let me live.

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  14. CSK says:

    @Michael Reynolds:
    Maybe, in his day, your father was full of cocky, sanctimonious bullshit himself.

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  15. Grommit Gunn says:

    I’ve got a friend who is an infectious disease pharmacist (specialized in HIV, but has been dealing with COVID in an “all hands on deck” capacity since it started).

    Per him, any booster is better than no booster. He did a mix and match purely because Pfizer was what was available at work the day he got boosted and it was convenient.

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  16. OzarkHillbilly says:

    @Michael Reynolds: Your father and my father must have been picking from the same miracle pile.

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  17. Neil J Hudelson says:

    Unlike my bourgeoise comrades on this thread, I chose the proletariat’s vaccine. One and done, let’s get this pandemic over with.

    But, after a long consideration, I did decide to get the Moderna booster–just a little bit, as a treat.

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  18. Joe says:

    “That’s bourgeois and conventional.”

    The current version per my 20-something kids, CSK, is “gawd, Dad, that’s so boojhie.”

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  19. Jax says:

    I was encouraged by how long the line was at our local drive-thru Covid/flu vaccine clinic today. Most are probably getting boosters or the flu shot, but it’s the first time I’ve had to wait at all! No new positive cases since last Thursday, either. Unfortunately, our deaths have increased by 4 over the weekend.

    I want the craziness/stress to be over so bad, I will confess that when they asked what shot I wanted, I almost said “Fuck it, let’s try them all!” No, Jax, it’s not a bar, you can’t just line up your vaccine shots. 😛

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  20. de stijl says:

    @Michael Reynolds:

    All the cool kids are getting x.

    At this point, what you get shot in your arm is way less important than that you do.

    I lack the knowledge and skill to pick and choose. I’ll take whatever you got.