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There has been a spate of FDA and CDC meetings recently where the agencies have discussed, debated, and then voted on whether or not to recommend booster shots of COVID-19 vaccines.

But the information has been coming in pieces, sometimes just days apart, leaving consumers, pharmacists, and even doctors confused about the official guidelines and what the next steps will be.


"It is confusing, I'll be very honest with you," said Dr. Jen Caudle, a board-certified family medicine physician and frequent Dr. Oz Show guest. "Even as a physician, I find myself combing through the guidelines over and over again, so if anybody out there is confused, you're not alone!"

What We Know

First up was Pfizer. In September, an FDA panel recommended a third, full-dose booster shot six months after receiving a second dose for certain populations — people 65 and over and adults 18 and over who are at a high risk for severe COVID (those with underlying conditions and/or people who work and live in places that puts them at a higher risk). The CDC then made its final approval. The Pfizer booster is currently FDA and CDC approved.

Then, on Oct. 14, it was Moderna's turn. The FDA's advisory panel of experts voted unanimously (19-0) to recommend a booster shot of the Moderna COVID-19 vaccine. Like the prior recommendations for the Pfizer vaccine, the Moderna booster is recommended for certain populations six months after the second dose, but with one big caveat: The dosage size is a half dose only for the Moderna booster (third shot). Despite voting to recommend a third dose, many of the FDA's scientific advisors noted that based on Moderna's data, most people who have received two doses of the vaccine remain "well protected."

Next up, on Oct. 15, was Johnson & Johnson (J&J). The FDA panel voted unanimously to recommend a J&J booster shot for all adults over 18 who already got the single dose. Because one dose of J&J's vaccine had been shown to be comparatively less effective than the two-dose mRNA Pfizer and Moderna vaccines, the panel recommended a booster two months after the solo J&J shot. Some committee members noted that the J&J vaccine should be considered a two-dose vaccine, like Moderna and Pfizer.

The CDC met on Oct. 21 and approved Moderna and J&J boosters as well as mix-and-match vaccine distribution if necessary. The CDC is still reviewing data and more guidelines and recommendations are to come.

What's Next?

The FDA and CDC made their final approvals on Moderna and J&J this week. Implementation could be immediate and as easy as going to your local drug store or pharmacy with your COVID vaccination card.

Check with your pharmacy and/or doctor for their policies.

An FDA advisory panel is meeting Tuesday, Oct. 26 to review data and vote on whether or not to recommend vaccines for children ages 5 to 11. Like the other reviews, if approved by the FDA, the CDC will then meet to discuss and vote.

Can You Mix and Match Boosters?

The FDA and CDC looked at a new pre-print study (has not yet been peer-reviewed) on mixing-and-matching vaccines.

The study found that those who had a mix-and-match booster (a combination of mRNA and/or J&J vaccines) had antibody increases that ranged from 6- to 76-fold after about two weeks.

Researchers say that "cross-dosing" is safe — if you got one of the three vaccines available in the U.S., you should be able to get a booster dose of a different one.

What's the Bottomline

A Pfizer booster is already approved by the FDA and the CDC for people over 65 and adults at a high-risk for severe COVID (based on personal health or live/work situations) six months after the second dose.

The FDA and CDC approved a half-dose booster of the Moderna vaccine 6 months after their second dose for adults over 65 and those at a higher risk of severe COVID, and a second full-dose of J&J, two months after the first, for everyone 18 and older, regardless severe COVID risk.

The agencies also approved a mix-and-match vaccine approach, saying that it is safe to "cross-dose" brands of vaccines.

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