Should I follow Pfizer with a J&J booster?
In this week's edition of the Covid Q&A, we look at mixing boosters. In hopes of making this very confusing time just a little less so, each week Bloomberg Prognosis is picking one question sent in by readers and putting it to experts in the field. This week's question comes to us from Robert in Norwalk, Connecticut. He asks:
We’ve heard about the positive effects of boosting the Johnson & Johnson shot with an mRNA one. Is there data on the reverse?
As more people become eligible for a booster, which shot to get has become the question of the hour. In the U.S., if you received the J&J single-dose vaccine and are over 18, the Centers for Disease Control and Prevention says you are eligible for a booster two months after your first shot. If you had a messenger RNA vaccine (those made by Pfizer or Moderna) at least six months ago, you’re currently eligible only if you are 65 or older, or over 18 and at high risk because of chronic medical conditions or potential work exposure. In either case, the agency says you can get boosted with any shot, regardless of which one you initially received.
Robert is right that there’s compelling evidence about mixing and matching vaccines. We’ve talked about mixing shots before in this newsletter. Different types of vaccines can boost the immune system in different ways, providing broader coverage. It’s not an uncommon practice for a single vaccine regimen to include more than one type of shot.
A study of nearly 700 people in Spain showed that people who got a dose of Pfizer’s vaccine after one dose of AstraZeneca’s saw protective antibodies climb sevenfold — a much more robust immune response than in those who just had two Astra doses. The AstraZeneca shot’s viral technology is similar to that used in the J&J vaccine. The key is mixing different types of vaccines.
“The data on the reverse vaccine order — mRNA followed up by a Johnson & Johnson vaccine — is not as compelling,” says Monica Gandhi, an infectious disease expert at the University of California, San Francisco.
In a mix-and-match study by the National Institutes of Health released this month, researchers looked at all three vaccines authorized or approved in the U.S boosted with a mixed vaccine — nine different combinations.
“The J&J vaccine followed by either the Moderna or Pfizer mRNA vaccines gave much higher antibody levels than the J&J followed by the J&J. However, there was no advantage of giving a J&J vaccine after the mRNA vaccines over a third mRNA shot in terms of antibody levels,” Gandhi says.
It’s important to keep in mind that these vaccines and this virus are all novel — our knowledge is changing every day, and our understanding of booster shots could very well change, too. But for now, the evidence suggests an mRNA booster is the best option no matter which vaccine you first received.
Thanks to all of you for writing in this week! Next Sunday, we'll be answering the best question we receive again. So if you have any, we want to hear from you. Write to us at CovidQs@bloomberg.net—Kristen V. Brown
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