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4th COVID shot available for immunocompromised people. Will they need one every year?

A healthcare worker fills a syringe with the Pfizer COVID-19 vaccine at Jackson Memorial Hospital in Miami.

Some people with weakened immune systems can now receive a fourth COVID-19 shot to boost protection against the disease, which they may not have received enough of the first, second or even third time around, according to updated guidance posted on the Centers for Disease Control and Prevention website.

COVID-19 vaccines do a remarkable job in protecting people from severe disease, but evidence shows immunocompromised people may not develop as robust antibody responses — or any at all. And doctors aren’t sure how that translates to protection against COVID-19 for anyone, though data from other vaccines shows higher antibody levels typically equal greater immunity.

In August, the CDC said people with weakened immune systems can get a third “additional” dose of either the Pfizer or Moderna coronavirus vaccines at least a month after their second dose of those same shots. Those who got the Johnson & Johnson vaccine were not eligible for an additional shot at the time.

Now, any adult who is moderately to severely immunocompromised and who received the Pfizer or Moderna vaccines can get a fourth “booster” shot of the Pfizer, Moderna or J&J vaccines at least six months after getting their third dose.

Also, adults with weakened immune systems who initially received a single dose of the J&J vaccine can now get a single booster shot of the J&J, Pfizer or Moderna vaccine at least two months after getting their first dose. The CDC emphasizes people who got the J&J vaccine should not receive more than two COVID-19 vaccine doses in total.

Any boosters of the Moderna vaccine are half the dose of the first two shots — 50 micrograms instead of 100 micrograms.

Essentially, the fourth dose for immunocompromised people serves the same purpose as the booster dose for those who don’t have weakened immune systems.

Will immunocompromised people need annual COVID-19 vaccines?

Experts agree more data is needed to know if people with weakened immune systems will need to get a COVID-19 vaccine every year. Researchers are still learning how long natural and vaccine-induced protection lasts for COVID-19.

Dr. Jessica Holzer, an assistant professor of public health at the University of New Haven in Connecticut, said vaccination for the coronavirus differs from that of the flu, which is recommended each year.

“It is too early to know for sure if annual or biannual vaccines will be necessary for COVID-19 like they are for the flu, regardless of the immune state of an individual,” Holzer told McClatchy News.

Because the flu mutates frequently, and much faster than the coronavirus, a different dominant strain circulates every year, meaning annual vaccines are needed to induce immunity against the new version.

But other viruses like the coronavirus that don’t change so often “can be managed with much less frequent vaccination.”

“It’s important to recognize that currently, we still have very high rates of transmission for COVID-19 throughout most of the U.S. and the rest of the world, so the pressure to provide repeat vaccination for the immunocompromised is high in the face of a direct and imminent threat to their health,” Holzer said.

“As the rates decline, which widespread vaccination will encourage, the pressure to mount annual vaccinations will likely also decline,” she added. “We are always reacting to the real state of the disease at the moment.”

Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, told McClatchy News “it’s unclear at this point what number of doses will be optimal for those who are immunocompromised.

“It is important to consider this group separate from other groups because of their inability to mount responses to vaccines and the fact that they were overrepresented amongst those with breakthrough hospitalizations.”

That’s why Adalja said guidance for people with weakened immune systems cannot be generalized to the “healthy population.”

Breakthrough cases are those that occur two or more weeks after complete vaccination, which for immunocompromised people is after their third dose. All others are considered fully vaccinated after their second dose if they got the Pfizer or Moderna vaccines and after their single dose if they received the J&J vaccine.

Will everyone need annual COVID-19 vaccines?

Again, it’s unclear if everyone will need annual COVID-19 vaccines regardless of the state of their health, but such a decision could be made depending on the type and distribution of COVID-19 cases, Holzer said.

“So if there appears to be significant risk of disease transmission continuing among the already-vaccinated because of mutations in the disease or other considerations, then yes we may see repeated boosters,” Holzer told McClatchy News.

“Ultimately, we’re working in an unknown because we have a novel disease and only about a year’s worth of vaccination follow-up in the broad population,” she added.