On March 29, the U.S. Food & Drug Administration authorized a second booster (fourth dose) of mRNA vaccines (Pfizer or Moderna) for people 50 years and up. The same day, Centers for Disease Control and Prevention recommended the same. 

"Getting more people who are 50 and older this additional booster dose will be a huge help in reducing hospitalization and death from the next COVID wave," says infectious diseases expert James Lawler, MD, MPH. "A booster gives you the best protection against omicron."

Who is eligible for a fourth dose?

• Adults 50 years and older who had a third dose more than four months previously 
• Immunocompromised individuals 12 years and older who had a third dose more than four months previously 

How many doses of COVID-19 vaccine should I get?

For best protection, current vaccination/booster* recommendations are:

Not immunocompromised, primary series with Pfizer or Moderna

• 5 to 11 years old: Two doses total (no booster) 
• 12 to 49 years old: Three doses total (one booster five months after second shot) – boost Pfizer only for age 12 to 17
• 50 years and older: Four doses total (second booster four months after first booster)

Not immunocompromised, primary series (one shot) with Johnson and Johnson

• 18 years and older: Three doses (second shot two months after first and booster four months after 2nd shot) 

Immunocompromised

• 5 to 11 years old: Three doses (third shot one month after second shot) – Pfizer only
• 12 years and older: Four doses (booster four months after third shot) – for age 12 to 17 boost with Pfizer only

*CDC recommends all booster doses be either Pfizer or Moderna**
**Moderna booster dose is 1/2 of primary series dose

For everyone 12 years and older, boosters (third doses) are available and strongly recommended.

Second boosters (fourth doses) are now available to adults 50 years and older who received their initial booster dose at least four months ago. 

Nebraska Medicine is only offering Pfizer COVID-19 booster vaccines at this time. If you previously received the Pfizer, Moderna or Johnson & Johnson COVID-19 vaccine, you can safely get a Pfizer COVID-19 vaccine for your third or fourth dose. 

Does the booster protect against omicron? 

Older adults have a higher overall risk from COVID-19. People who are 55 and up account for 89.6% of COVID-19 deaths in Douglas County. The average age of COVID-19 deaths for Douglas County residents is 76 years old.

The Kaiser Family Foundation found that among severe breakthrough infections, 69% were among adults 65 and up. COVID-19 vaccines remain effective at preventing severe disease, but their effectiveness may wane over time – especially in older adults.

 
But getting a booster increases your protection against omicron. An mRNA vaccine booster had 90% efficacy against COVID-19-associated hospitalizations while omicron was dominant. 

A preprint study (not peer-reviewed yet) shows a fourth dose of Pfizer increased protection for people 60 years and up in Israel. The likelihood of severe COVID-19 illness was four times lower for people with a fourth dose, compared to people with three doses.

Do booster shots use the same ingredients as existing vaccines?

Yes. COVID-19 booster shots are the same ingredients (formulation) as the current COVID-19 vaccines. However, in the case of the Moderna COVID-19 vaccine booster shot, the dose is half of the amount of the vaccine people get for their primary series.

Are breakthrough infections evidence that vaccines don't work?

No. Because no vaccine is 100% effective, it is expected that some people will test positive even after being vaccinated. Breakthrough infections are not evidence that the vaccines are flawed. The vaccines are designed to protect you from severe disease and death due to COVID-19.

Vaccination (including boosters when you're eligible) remains the best protection against severe COVID-19 outcomes.

Is it too late to get vaccinated?

No. COVID-19 is largely preventable through public health protections like masks, vaccinations, boosters and distancing.

If you haven't been vaccinated against COVID-19, you have a higher risk of dying from COVID-19. Please get vaccinated to protect yourself against the more contagious omicron variant.

 
Source: CDC Rates of COVID-19 Cases and Deaths by Vaccine Status