November 19, 2021

By Ian Prasad Philbrick and Claire Moses

Good morning. The U.S. may soon offer booster shots to every adult. We'll explain why.

Receiving a booster in Anchorage.Ash Adams for The New York Times

Boosters for all?

The federal government's guidance on Covid booster shots has often been confusing, but it looks as if it's about to become much simpler.

The F.D.A. appears to be on the verge of authorizing Moderna and Pfizer booster shots for all adults in the U.S. If it does, anyone over 18 can get a booster, as long as it's been at least six months since their last shot. (The C.D.C. has said that adults who received the one-dose Johnson & Johnson vaccine should get a booster at least two months later.)

Dr. Anthony Fauci has become "a very, very relentless advocate" for boosters, The Times's Sharon LaFraniere, who covers the federal government's response to the pandemic, told us. "He keeps pointing out that the data is getting stronger."

Today we'll walk you through what's compelling regulators to widen eligibility, who needs the shots most and how to get one.

Why now?

First, immunity is waning. While experts debate the pace at which the vaccines become less effective, there's strong evidence that they do lose some of their ability to prevent Covid infections. (These charts show the decline.) While the vaccines' protection against severe disease mostly holds, some studies suggest they become somewhat less effective at doing so, particularly for older people or others with underlying medical conditions.

Second, expanding booster access is simpler than asking Americans to consult a list of rules to determine whether they're eligible. As our colleague Apoorva Mandavilli put it, "It's easier to just tell people to get them."

Third, broadening eligibility to all adults would bring the U.S. in line with the approach of other countries, including Israel and Canada. Several U.S. states have begun expanding booster access on their own, essentially declaring that they couldn't wait for the federal government.

"Critics would say that the C.D.C. is starting to look more like a caboose than a locomotive," Sharon says. If the agency recommends boosters for all adults, "they're just authorizing what's already happening."

Who should get one?

The government has already recommended that older adults, people 50 and up with underlying medical conditions and those who are immunocompromised get an additional shot. And the C.D.C. has allowed boosters for many others.

"I've urged everyone I know who is higher risk to get a booster," Zeynep Tufekci, the sociologist and Times Opinion columnist, writes.

Some experts believe that the urgency for younger, healthier Americans to get a booster is lower. But others have started to make the case for it. "All vaccinated adults would benefit from a booster," Dr. Ashish Jha of Brown University wrote yesterday in The Atlantic.

Why? Cases are rising again — as of Wednesday, the U.S. was averaging over 88,000 new cases a day, up 23 percent from two weeks ago — and another winter surge seems possible, particularly in parts of the country with lower vaccination rates. (Look up your county's numbers.) That increases the urgency of getting more Americans as much protection as they can.

Chart shows 7-day daily average.Source: New York Times database

And although new infections are concentrated among the unvaccinated, Jha notes, breakthrough infections have become more common. For younger and healthier adults, getting a booster can lessen the chances of getting sick and of spreading the virus to someone more vulnerable.

And boosters appear to work. Evidence from Israel, which has offered extra shots to all adults, suggests that a third Pfizer dose increases protection against infection to a level similar to the vaccine's initial efficacy.

How do I get one?

Once the government broadens eligibility, you'll be able to go to your local pharmacy, a doctor's office or anywhere else where vaccines are available.

Mixing and matching different types of vaccines seems to provide a stronger immune response, Apoorva says, especially if you get a Moderna one after two Pfizer shots or following the single-dose of J.&J.

Is it ethical?

Some public health experts have urged the U.S. and other countries not to make boosters widely available. They argue that doing so will limit the supply of shots for the rest of the world, especially for residents of less wealthy countries.

But as Sharon notes, the U.S. government has already stockpiled enough vaccine doses to give boosters to the adult population. And the Biden administration, under pressure to increase the supply to poor nations, is planning to expand manufacturing capacity with the goal of producing at least a billion more doses a year.

Millions of doses have already been distributed to pharmacies and clinics around the U.S. "They cannot be recaptured and sent abroad," Jha writes. "Either we use those doses here or we throw them away."

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