COVID-19 vaccine dose #4 - yes? or wait?
July 6, 2022 7:49 PM   Subscribe

I'm eligible for a 2nd booster (4th dose) of vaccine for COVID-19. Should I take it now, or wait (for an omicron-specific vaccine? or a time when I will need it more?) Despite the characteristically mild Australian winter, snowflakes follow...

I'm a woman in my 40s. Because of my weight (BMI>40) I'm eligible for a "winter booster"/4th dose of COVID 19 vaccine. I am prone to asthma symptoms/bronchospasm when I get a respiratory infection, but don't meet diagnosis for chronic asthma. I have also had pneumonia before - this was in my 20s, and while it was the sickest I've ever been, I didn't require hospitalisation.

Notwithstanding those things, I am in OK health. I have so far managed to dodge COVID infection.

In the past I've described myself as a "vaccine enthusiast", or whatever you want to name the opposite of vaccine hesitancy - I booked in for my first two doses, and then for my booster (all Pfizer), as soon as I was eligible. I've hung back from the "winter booster" for a couple of reasons:
  • I've heard that 3 doses provides a decent level of protection from serious disease, and that the additional protection from a 4th dose - possibly enabling one to chase the virus off without becoming infected - gets shorter for successive doses (I haven't read the studies myself, but this was reported on Coronacast, a source I trust). It's winter in the southern hemisphere and we're having an awful flu season, so the push is on to get people boosted now. However, I'm thinking of travelling overseas later in the year, and wonder if the extra protection would be of more benefit to me then.
  • I read news stories about possible tweaks to the vaccine "recipe" to make them more protective against Omicron and its variants. If I have a regular booster now, I might well not be eligible for one of these targeted boosters later.
The Question: What should I do, or what should I consider when making this decision?

*In case this comes up - I have a great GP/PCP, who would probably have excellent insight into this question. However, I'm not going to raise it with them because I don't want them to start seeing all of my medical care through the "fat lady" lens, and I think this is a risk if I start talking about this with them.
posted by Cheese Monster to Health & Fitness (19 answers total) 5 users marked this as a favorite
Get the shot. I have had all 4 (Canada) and when the next one is available this Fall, I'll be signing up right away. I see no benefit in waiting. If it's flu season, all the more reason to get the flu shot, too. Why risk more damage to your respiratory system if you don't need to? Also, you will be protecting everyone you come into contact with. Take care of yourself and protect others.
It's a win-win.
posted by Enid Lareg at 9:01 PM on July 6, 2022 [6 favorites]

Bird in the hand = 2*(birds in the bush). Get the one now.
posted by Fiasco da Gama at 9:32 PM on July 6, 2022 [1 favorite]

Best answer: I say get it too - I’m also in Australia and got my 4th shot a month ago. Had to make an emergency trip to Melbourne last week and was really glad I’d been boosted. You never know what will come up in the way of exposure between now and your planned trip. Eligibility is being widened for the 4th shot which indicates to me that there’s government awareness that BA4 and 5 (R0 of 18?!) are going to be bad news. As for variant specific vaccines, who knows when they’ll be available. The TGA and ATAGI haven’t exactly distinguished themselves by their speed of decision making so far, it could easily be months away.
posted by t0astie at 9:34 PM on July 6, 2022 [1 favorite]

The sooner you get this one, the sooner you can get the next (subvariant-targeting) one.
posted by aramaic at 10:04 PM on July 6, 2022 [12 favorites]

Best answer: I just had my 4th dose yesterday, and will be in line for any new vaccines as they become available. I completely understand your concern - my 3rd shot was in early January and I have travel coming up and the idea of being on a long-haul flight right now, with the background of rising cases of BA4/BA5 is...unappealing.

Raina MacIntyre addresses your concerns about whether dose 4 is worthwhile (it is) and whether we should wait for the newer vaccines instead (no, too much uncertainty about when they may become available) in this article.

Edited to add: I'm in Australia, too.
posted by lulu68 at 11:42 PM on July 6, 2022 [1 favorite]

Best answer: Another fat 40-something woman in Oz here, I got my 4th dose about a month ago. I say go for it. I feel like almost everyone I know is getting corona and though I haven't I feel a lot better about my chances of getting through ok having had that fourth dose. And yes, as aramaic points out, the sooner you get it, the sooner you are eligible for another booster when it becomes available.

My advice: make sure the place you are getting the booster is up to date on eligibility. Despite making an appointment, I had to argue with the chemist who didn't think I was eligible because I wasn't old enough, despite being eligible both because of BMI and having diabetes. It took a bit of wrangling and I did get it in the end, but better to have that conversation beforehand than on the spot.
posted by Athanassiel at 12:19 AM on July 7, 2022 [1 favorite]

Best answer: As a fellow Aussie who came down with coronavirus yesterday after three shots and is feeling pretty miserable:

Get the fourth shot. No rules now apart from being over 30.
posted by some little punk in a rocket at 12:28 AM on July 7, 2022

Best answer: Get the shot.

It's not being reported much, but Australia has among the highest rates of active transmission right now - a few weeks back we had the highest. The idea there are places worse than us and that we're somehow 'safer' is a comfortable bit of self delusion left over from when we were doing a much better job of containment. I don't know where you're planning on traveling, but you can't assume their rates of infection will be worse than ours, especially that far into the future. You can, however, look at what's happening now, and that's tens of thousands of new cases a day.

If you pick corona up over winter your trip may well be off. This won't wreck your trip, it may well protect you enough so you get to have it.
posted by Jilder at 3:06 AM on July 7, 2022 [1 favorite]

You can get both shots. Get your 2nd booster now. Get the omicron specific this fall.
posted by Geckwoistmeinauto at 4:15 AM on July 7, 2022

I'd add an "if". Get the shot now if your previous shot was more than 6 months ago. This is not about waning protection, but because a longer gap can improve the effectiveness of the shot.
posted by SemiSalt at 4:35 AM on July 7, 2022 [1 favorite]

Get the next shot. I had an extraordinarily mild case of COVID recently because I was double vaxxed and double boosted, and I will get the next shot too if/when they come out with the ommicron specific.
posted by Peach at 5:31 AM on July 7, 2022

Best answer: Epidemiologist here. Get your booster whenever it's available and as soon as you're eligible. It won't preclude you from access to additional boosters. There's no gain from trying to anticipate what comes next in product approvals.
posted by late afternoon dreaming hotel at 5:39 AM on July 7, 2022 [8 favorites]

Get the shot now. The future of variant-specific vaccines looks about as rosy as flu variant-specific vaccines--it's an educated guess that sometimes does not match the the variant with the highest prevalence. In any case, there's also a vaccine under development that would work (to an as yet unknown degree) regardless of variant because the spike protein shape wouldn't figure into it.

There is mounting evidence that even asymptomatic infections greatly increase risks of adverse health outcomes from long covid sequelae such as multiple organ damage. Especially if you have health risks such as elevated BMI. (So do I, btw.)
posted by ImproviseOrDie at 5:43 AM on July 7, 2022 [1 favorite]

Best answer: This is a long-but-thorough twitter thread answering your question, the summary is if you're over 50, or are at high risk, then definitely get the booster now - it will cut your mortality rate by 4x. Then you can get a more targeted booster later when it's available.

The latest strain of COVID (BA.5) is highly contagious and is not being blocked by the vaccine, booster, nor immunity from previous infection, but the vaccine and boosters will still prevent you from being seriously sick & hospitalized. That is why it's important to get the booster now and not wait - you're much more likely to catch this strain and you want to do all you can to reduce its impact.
posted by jpeacock at 7:39 AM on July 7, 2022 [2 favorites]

Get the shot. I dragged my heels on the booster after having a terrible reaction to the initial two shots, and now have COVID. My boosted partner? Not a sniffle.
posted by Torosaurus at 10:03 AM on July 7, 2022 [1 favorite]

Best answer: it will cut your mortality rate by 4x

Maybe even higher - some estimates put it at 14x.

To be fair, that's a large reduction in an already small number, but why not?

posted by soylent00FF00 at 4:53 PM on July 7, 2022 [1 favorite]

I too have been putting off my 4th shot for the tweaked shot. You have convinced me…

Next Wednesday.

And it is weird to read “it’s flu season”, and then you realize the Southern Hemisphere….
posted by Windopaene at 7:47 PM on July 7, 2022

Response by poster: Thanks everyone, I got jab #4 today. All the comments, and particularly the unanimity of the comments, were helpful, but special thanks for the authoritative references and the Australia-specific advice.

Get well soon, some little punk in a rocket and Torosaurus, and stay safe, everyone.
posted by Cheese Monster at 1:48 AM on July 11, 2022 [3 favorites]

Response by poster: A final update: I ended up testing positive for COVID about 2 weeks after my booster. I'm not sure if the booster helped or not - it was still pretty awful but I did not require medical assistance.

Since I got the virus from my partner, my final tips are:
  • Make sure your household also gets boosted! and
  • Do a RAT the day after your booster because the vaccine side-effects can easily hide the signs of COVID infection!

posted by Cheese Monster at 7:34 PM on August 3, 2022

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