Dr. Gottlieb on Booster Shots: It’s Complicated

It depends on what the goal of vaccination is,

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Who should get a booster shot? It depends, Dr. Scott Gottlieb says.

Maria Cruz, a nurse, receiving a Covid-19 booster shot in Alaska last month.Credit…Ash Adams for The New York Times

Nov. 21, 2021, 4:40 p.m. ET

Who should get Covid-19 vaccine boosters? That depends on the public health goal, said Dr. Scott Gottlieb, the former commissioner of the Food and Drug Administration.

On Friday, the F.D.A. endorsed Moderna and Pfizer-BioNTech vaccine boosters for all adults, but did not require that people have boosters to be considered fully vaccinated.

The Centers for Disease Control and Prevention agreed with the F.D.A. later on Friday and currently advises that those 50 years and older, or adult residents in long-term care, “should” get a Moderna or Pfizer booster, while other adults “may” get one. The agency also advises that all adults who received the Johnson & Johnson shot should get boosted.

Speaking Sunday on the CBS show “Face the Nation” about the current recommendations, Dr. Gottlieb said that there are two views about the goal of boosters: If vaccines are meant to protect people from severe Covid infections, they should be recommended for people over 50. Immunity from vaccines wanes in older people after six months, placing them at increased risk for a serious infection and, Dr. Gottlieb said, “a bad outcome.”

But, he added, if the goal of boosters is to slow or stop transmission of the coronavirus, they should be recommended for younger people. Boosters may not help those individuals avoid severe disease because their immunity is already good, Dr. Gottlieb said, but they can prevent younger people from infecting others.

“You’re recommending the booster as a tool to try to make them less likely to pass on the virus,” he explained.

That sort of strategy is not new to the infectious disease world. Boys are immunized against rubella, or German measles. But the goal is not to protect them — the disease is mild in children. Instead, it is to prevent boys from spreading the virus to pregnant women — rubella can cause severe birth defects.

Girls, too, are immunized against rubella to prevent them from spreading the virus, but also to protect their fetuses when they are older, if they become pregnant.

For now, the booster situation is unsettled, and recommendations can vary state to state. Only the governors of Connecticut and New Mexico have said that, to be fully vaccinated, everyone needs three doses of a Covid vaccine. Dr. Gottlieb said he did not think the C.D.C. would recommend that everyone get three doses any time soon because of the debate among public health experts over the goal of vaccination.

He added, “the C.D.C.’s sort of stuttering approach to how they’ve embraced boosters is sort of reflective of that debate.”

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