FDA authorizes Johnson & Johnson booster: What to know

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The US Food and Drug Administration authorized booster shots Wednesday for everyone who received Johnson & Johnson, the only one-dose coronavirus vaccine, at least two months after their shot. And the agency didn’t just authorize a second dose of Johnson & Johnson, they also gave all eligible booster participants the ability to “mix and match” COVID-19 vaccines for a booster, meaning those who got J&J could get a dose of Pfizer or Moderna instead. 

The fact that all Johnson & Johnson recipients are eligible for a booster shot is a testament to the opinion of many health officials who say Johnson & Johnson probably should’ve been a two-dose vaccine from the start. The FDA also authorized booster shots for some Moderna recipients Wednesday, including people age 65 and older, adults at risk of severe COVID-19 and adults whose jobs put them at risk of COVID-19 transmission. The people who are eligible for Moderna’s booster are the same people who are eligible for Pfizer’s booster. 

Read more: FDA officially authorizes mixing COVID boosters: What to know

Fewer people have gotten Johnson & Johnson’s one-dose vaccine than Pfizer or Moderna. About 15 million people have been vaccinated with J&J, according to the CDC, a small number compared with those vaccinated with Pfizer or Moderna. This is partly because it was available in the US later than both mRNA vaccines, production issues resulted in millions of wasted doses and use was paused briefly in April after concerns over a link to a rare but serious blood clotting disorder (mostly in women under age 50) that isn’t seen with the mRNA vaccines. 

Those who got the one-dose J&J vaccine, including immunocompromised people, were initially left out of the country’s booster shot plans because of a lack of data on the one-dose vaccine. (The booster rollout in general is a controversial one — members of the World Health Organization have called on countries such as the US to slow the process of giving booster doses to people who are already vaccinated because much of the world remains unvaccinated against COVID-19. As few as 2.7% of people in low-income countries have had a coronavirus vaccine, according to Our World in Data.) 

While health agencies continue to iron out booster recommendations, here’s what we know now about second shots of Johnson & Johnson. 

J&J booster: A long time coming

There have been many experts who disagree with the CDC and FDA’s stance on waiting for more data when it comes to those who are more vulnerable to severe COVID-19 and who received J&J. Research shows that viral vector vaccines like J&J and AstraZeneca are likely less effective than mRNA vaccines. This was confirmed at the recent FDA committee meeting, where members voted to recommend boosters of Johnson & Johnson based on less-than-perfect data provided to and reviewed by the FDA.

In an editorial for the Washington Post on why public health agencies should allow J&J recipients to receive a dose of mRNA vaccine, CNN medical analyst Dr. Leana Wen wrote: “This isn’t a one-size-fits-all recommendation, but rather an individualized decision based on people’s medical circumstances and exposures.”

While a healthy younger person is probably adequately protected with Johnson & Johnson, someone who is severely immunocompromised is “likely not optimally protected by the J&J,” Wen said, and the unknown risks of mixing vaccine types are “almost certainly” outweighed by the risks of severe COVID-19. 

There may be some local exceptions: For example, if you live in San Francisco and received J&J, you can get a dose of Pfizer or Moderna. However, the city’s health department stresses that this is not a recommendation or change in policy, but an “accommodation” for Johnson & Johnson recipients who’ve asked their physicians about receiving a dose of mRNA vaccine. 


If or when boosters become a reality in the US, it’s unclear how that will change the CDC’s definition of “fully vaccinated,” or how that will vary based on the type of vaccine you received. 

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When will I get a J&J booster?

Now that it’s authorized, it will be up to the CDC to recommend how people seek out booster shots if they received Johnson & Johnson, or if the agency will issue a strong recommendation for some J&J recipients while simply saying other people who got J&J “may” get a booster. For example, the CDC says now that Pfizer recipients age 65 and older and people with certain health conditions “should” get a third shot, while other Pfizer recipients who are at risk because of their job or are younger adults with health conditions “may” get a booster if they choose.

Does it matter what vaccine I get as a booster?

We’ll know more after the CDC issues guidance on the Johnson & Johnson booster. The CDC may recommend that it’s best for people to receive the same vaccine as a booster, or it may recommend that certain groups seek out a different COVID-19 vaccine as an extra shot.

However, some experts believe that J&J recipients may benefit from receiving a different vaccine, as seen in preliminary data on mixing COVID-19 vaccines that was discussed at the FDA committee meeting last week. The data showed that antibody levels (though far from the full measure of immunity) rose 76-fold in J&J recipients who received Moderna as a booster, 35-fold with a Pfizer booster and only four-fold with a Johnson & Johnson shot.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

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