«  View All Posts

COVID-19 Update 10/20: Booster Doses, COVID and Flu, and More

October 20th, 2021 | 8 min. read

By Steve E. Bishop, M.D.

COVID-19 Update 10/20: Booster Doses, COVID and Flu, and More

On this week's COVID-19 update, Dr. Bishop discussed what's happening with booster doses for Moderna and J&J and when they might be ready, data on getting COVID vaccines and flu shots at the same time, and the potential for mix-and-match COVID vaccinations. 

Watch the video below and read on for a full recap. 

(Editor's Note: This update was recorded Wednesday afternoon before the CDC made any official decisions regarding Moderna and J&J boosters.)

Vaccine Reset: Where We Are with Pfizer, Moderna, and J&J

Let me just start by reiterating and reminding people where we are from last week. We've got the Pfizer vaccine, and that was approved by both FDA and the CDC's Advisory Committee on Immunization Practices, or ACIP.

They've approved the Pfizer vaccine for a booster six months after your second dose for basically any adult who wants to get one. But they specifically recommended it for people 65 and up and people 18 to 64 who have underlying health conditions that put them at higher risk, or they work in a job where they're at higher risk of exposure, like healthcare.

Moderna ended up getting a similar nod last week from the FDA, and the CDC's ACIP committee is going to take that question up Thursday for Moderna.

I suspect they will go ahead and, just like they did for Pfizer, approve it for adults 65 and up as a recommended booster six months after your second dose and for those 18 to 64, either with underlying conditions or who have unusual exposure risks based on occupation.

What's interesting about the Moderna booster is it's a half dose compared to the first two doses. It has a little bit less of the antigen dose in there, which is a good thing.

They got similar boosting efficacy in terms of getting the antibody levels up with half a dose compared to a third full dose, so I think that's good. As with all things in medication, the less you can get away with, the better off you are, so if you can give less of a dose and get the same response, that's a good thing.

It's probably going to lead to fewer side effects, in the short term, in terms of getting the booster doses, which is a good thing.

J&J, similar thing. FDA gave approval last week for anyone who's gotten J&J to get a booster two months after you got your first dose.

I almost think of it as — it's not so much a booster. It's really sort of the second shot in the primary series. So you're getting it two months after your first dose, and they recommend that for everybody.

I think what they're really saying here is that the series is two doses. You need to get the second two months after the first one. That brought that level of protection from hospitalization and fatality back up and improved it compared to one dose.

So if you got J&J, ACIP will probably make a recommendation tomorrow. And then probably next week, you should, assuming they approve like we expect them to, go ahead and get your second dose of J&J if you already got one dose of J&J. That will be the finish to the primary series or the booster. However you want to think of it. You need a second shot. So you should go ahead and get that.

And that's going to be a recommendation for everybody who got a first dose of J&J. Go ahead and get the second one. That's going to kind of make things a little bit more in line compared to the Moderna and the Pfizer vaccines as well.

That's where we are with the three main vaccines.

Getting COVID Vaccines and Flu Shots Together

I want to just share some interesting data that got passed along to me earlier today. We are in the flu season. We are having and seeing a fair amount of flu at this point. It's not dramatic, but it was considered regional spread last time I checked the Virginia Department of Health's website. That can change from locality to locality, but we are having spread of influenza, both influenza A and B.

So please go ahead and do get your flu vaccine. It's time. If you haven't gotten it done already, please go ahead and get it now. We recommend that for everybody as long as you're in the approval window. Everybody six months and up, get your flu shot. It's time.

And then many people have questions — if I'm supposed to get a Moderna booster or a Pfizer booster, or now I have to get another J&J, can I go and get the flu shot at the same time?

The answer is yes. Yes, you can. It is safe. The CDC and FDA have cleared that. We've been doing it for a couple of months now. There's no need to separate them. There does not seem to be any problem, and here is a link to a study analyzing data about this.

You can peruse through the data from Sanofi, one of the makers of these vaccines, checking in on the safety of giving those vaccines at the same time as a Moderna booster. And that was a full dose booster, by the way, the 100mcg booster, the third dose that was recommended for immunocompromised people earlier in the summer.

Most of you guys, if you're getting a Moderna booster, you'll get the 50mcg dose or the half dose.

What they saw in this study was that both vaccines — given together, even at the same time, same day, same person — they worked just as well together as they do independently in terms of getting the antibody levels up. There wasn't any problem with one vaccine inhibiting the other one.

And there were no increased issues with safety in terms of bad side effects or anything of that nature. In fact, the combo group actually had slightly less of the side effect rate and profile than people who go either shot on its own, which is sort of interesting.

That's just based on my early read of the data, but the combo people actually seem to have fewer side effects than people getting the mRNA vaccine, the Moderna vaccine booster, by itself.

That's good. Getting the two at once is not really an issue in terms of short-term side effects and there shouldn't be any new problems in terms of long-term side effects from combining them.

Separating a vaccine out by a couple of weeks isn't going to make a big difference in terms of long-term side effects, one way or the other. The big concern is short-term side effects. Is it going to be an issue in terms of either the vaccines inhibiting the immune system recognition and antibody formation or short-term fever, chills, muscle aches, injection site pain, that kind of stuff.

And the two answers to those questions are:

  1. It doesn't seem to inhibit antibody formation.
  2. The side effect profile is no worse and maybe even better in people getting the combo vaccine versus just getting the Moderna vaccine alone.

That, again, is kind of interesting. I don't know the mechanism behind that, but I'll take it as good news. Certainly more side effects in the Moderna group, compared to just flu shot alone.

But we already knew that from our now nearly one year of data using Moderna vaccines. It's hard to believe. It's almost a year now we've been using these vaccines.

Combo Vaccines in the Future

The reason I think that's interesting is cause I think what you'll probably see in the coming years — especially if we find the need to keep giving booster vaccines for COVID, especially for our older population who are at risk both for COVID and for flu — you may see the emergence of combined vaccine products where it's just one injection with two vaccines in it.

remember, we do this for all kinds of things. that wouldn't be a new thing in terms of vaccinations. Many people have gotten a tetanus shot before, right?

A tetanus shot is frequently not just tetanus. Most people don't know that "tetanus shot" is often the Tdap vaccination. it's actually tetanus, diphtheria, and pertussis all in one vaccine.

We give this routinely to adults all the time every 5 to 10 years. Combining different vaccines into a single shot is very common and done very frequently. I'm not concerned about that. I think it's a good thing. It makes things more convenient. As long as the safety data is there to support it, it's a good thing to do. I suspect that we'll have that out next year. We'll have a combination product would be my guess, so we'll see where things go, but that's my suspicion.

Vaccines for Children

"What is happening with vaccines for 5 to 11-year-olds?"

Yes, that is an excellent question. I think everyone's waiting to hear what's going to happen with that. I think we're supposed to get something on the books for reviewing that data and getting a decision from the FDA by the end of October. So, soon.

I suspect early November, we'll have sort of an answer on that question of, are we going to get the vaccine for 5 to 11-year-olds? And if so, is it going to be a blanket approval? Is it just going to be for certain groups of kids? What's that going to look like?

My guess is will be early November. 

(Editor's Note: The FDA is meeting to review Pfizer's data for 5 to 11-year-olds on October 26. The CDC's ACIP will then meet on Nov 2-3.)

J&J Booster After 6-8 Months?

"Is there any data around people getting the J&J booster six to eight months out?"

Just a smidge of data on getting it after six months. Most of the data that we have is getting it at two months. Getting it two months after the first dose was the majority of the data that J&J presented.

But if it has been six to eight months since you've gotten yours, assuming it's approved Thursday, go ahead and get your second dose now.

There's no reason to suspect that that wouldn't be just as equally helpful as getting it after two months. I would go ahead and do that. It would make sense.

Boosters for Under 65

"When do you think people under 65 will be able to get the booster shot?"

So, pretty much anyone 18 and up who wants to get a booster dose of either Pfizer and probably for Moderna after Thursday can get one.

18 to 64 is for "high risk" people in those categories, and that always includes a list of specific diagnoses, but also a caveat for "as recommended by your physician."

If you are someone who is high risk because of a specific condition, or you just feel you're high risk, and you want to boost your dose, there really won't be anything stopping you from getting that booster.

That's why I said this is available for anyone who wants one, 18 to 64. So they should be available again probably by next week if you want to get a booster dose. And I think that's fine.

Mix-and-Match Vaccines

"The New York Times reported they expect the FDA to authorize mixing vaccines. If they do this, would your recommendation for J&J recipients be to get an mRNA booster? Seems like Moderna releases a stronger response for J&J people?"

Yeah, so I think that's a reasonable consideration. What I would say is that the data on mixing them is pretty limited, and FDA is going to be making decisions based on pretty limited data.

I think you're just as well off doing either one — getting a dose of one of the mRNA vaccines after J&J or just getting the second J&J dose.

I think either of those is perfectly fine and reasonable for you to do. I'm not sure I would get the two doses of J&J and then a dose of one of the mRNAs.

I think that might be kind of going beyond the bounds of what we have data on. We do have a little bit of data on mixing and matching the J and J's with the mRNA vaccines, so I think that's generally safe to do — one dose of each.

I haven't seen any data on two doses of J&J plus a dose of Moderna or Pfizer, so I wouldn't do that. But if you wanted to do J&J followed by one of the mRNAs, I think that's totally reasonable.

And I suspect the FDA will give their blessing to that this week as well. It should be soon. The data though is limited. We don't have a lot of data on that because it hasn't been studied officially on a wide-scale basis, but good question.

"Does the mix and match recommendation apply to Moderna recipients getting Pfizer and vice versa?"

It will. When they issue it, they'll probably say you can mix and match in any way that makes sense to you.

No problem going from a Moderna to Pfizer, and I think that's probably what they're going to come out with. And again, recognizing we don't really have much data at all on this in terms of mixing and matching the vaccines, but based on the data that is available, it does appear to be safe and reasonable to do so.

When is the next update? 

The next update will be on Wednesday, October 27 at 1:00 pm on our Facebook page. For those without Facebook, we will post our written recap on Thursday morning. 

Steve E. Bishop, M.D.

As a board-certified internist and concierge doctor in Richmond, VA, Dr. Steven Bishop is passionate about helping his patients improve their lives through better health. He helps healthy adults adjust their lifestyles as they age and helps patients with complex medical diseases manage and improve their health.