Approval has now been given for booster doses. However, that has come with some confusion. Part of that is related to the fact that the Johnson and Johnson (J&J) only has one dose. Another part of that is related to the fact that there has also been approval for mixing and matching of vaccines.

Those fully vaccinated with Pfizer can receive a booster dose for those over age 65, those ages 18-64 at high risk or those in high risk occupations.  It can be given six months after the last dose. That booster dose can be another full dose of Pfizer vaccine. It can also be a dose of Moderna vaccine. It can also be a dose of J&J vaccine.

Those fully vaccinated with Moderna can receive a booster dose for those over age 65, those ages 18-64 at high risk or those in high risk occupations. It can be given six months after the last dose. The booster dose can be a half dose of the original Moderna shot. It can also be a dose of Pfizer vaccine. It can also be a dose of J&J vaccine.

Those who have received a single dose of J&J vaccine can receive a second dose of the vaccine. That is true for all recipients. Thus anyone over age 18 who has had the vaccine can get a booster. It can be given two months after the first dose. That booster can be a second J&J shot. It can be a Pfizer or Moderna booster.

The mix and match vaccine policy might have people further confused. However, there is some evidence that it provides stronger immunity than a single vaccine alone. That is logical. The vaccines are made a little differently. Therefore, they result in antibodies that are a little bit different. The more different antibodies, the better the protection.

Data has suggested this appears to be the case for J&J vaccine followed by either Pfizer or Moderna. J&J followed by Moderna raised antibody levels the most. J&J followed by a second J&J raised antibody levels the least. Pfizer was in between.

There does not appear to be any data for J&J following Moderna or Pfizer vaccine. However, since the vaccine is a different type, it would be logical to expect it to create a different group of antibodies than the original vaccines. It is a more traditionally made vaccine than the others as well.

The result of all of this is that it is now up to each individual to look at their own vaccine situation. They can then decide if they are in an eligible group for a Pfizer or Moderna booster or second dose of J&J. They can then decide if they want the same vaccine or a different one. Those who are not yet eligible are likely to become eligible in the future. They will be faced with the same decision.

So, for example, I have had two doses of Moderna vaccine. I can take the third half dose of Moderna. I can take the J&J. I can take the Pfizer. The Pfizer offers little additional benefit since it is an mRNA vaccine like Moderna. The J&J theoretically would offer better protection but the data is not yet in on that. The half dose of Moderna would give me a boost with a vaccine that I know did not cause significant side effects the first time.

When vaccines were first available, the recommendation was to get the first one available. Now that there are so many options, the decision becomes more complicated. It also becomes more individualized. You might still choose the first available. However, you might want to choose a specific vaccine for the booster.

There is indeed confusion. However, hopefully the laying out of options will help decrease that confusion for those eligible for a booster.

COVID update- The number of new cases nationally dropped from 588,000 last week to 520,000 this week. The number of new cases in Sussex County went from 832 two weeks ago to 639 last week. This week they were 581. So both nationally and locally the numbers continue to drop.

The CDC still considers the current level of cases in Sussex County to be high. That means that masks should be worn by both vaccinated and unvaccinated individuals when indoors without social distancing for extended periods.

Comparative data is now available for breakthrough infection rates by vaccine. Those who received Moderna have 8.63 infections per 10,000 individuals. Those who received Pfizer have 13.56 infections per 10,000 people. Those who received Johnson and Johnson have 17.19 infections per 10,000 people. By comparison, unvaccinated individuals have 73.67 infections per 10,000 people.

The CDC looked at deaths from non-COVID causes in vaccinated vs. unvaccinated individuals. Unvaccinated individuals were about three times as likely to die from non-COVID causes as those with two doses of mRNA vaccine. This would suggest that individuals who choose to not get the vaccine are not as healthy in general as those who choose to do so.

A good example of this is a study done by the Addiction Policy Forum. They found that 50 percent of patients being treated for substance abuse objected to COVID-19 vaccination. Another example is a study that looked at cigarette smokers. About twice as many cigarette smokers are against the vaccine as opposed to non-smokers. As expected unvaccinated individuals in general also do not get the annual flu vaccine. Thus, those who choose not to get the vaccine tend to be individuals who have other risky health behaviors.