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Do You Need a “Mix-and-Match” COVID Booster Shot? New Approval, Explained

While we await on the CDC's final guidance on mix-and-match booster shots, here's what the FDA's approval means.


On Wednesday, October 20th, the Food and Drug Administration (FDA) approved booster shots of both the Moderna and the Johnson and Johnson vaccinations against COVID-19, reports STAT. The agency also approved a so-called “mix and match” strategy, where people could receive a different vaccine booster than what they received for their initial dose.

A group of CDC advisors is meeting today to discuss the mixing strategy, as well as guidance for who receives these boosters, STAT reports, and their decision, if approved by the CDC Director, will set guidance on boosters across the country.

What Did the FDA Approve?

The FDA has approved a Moderna booster for anyone older than 65, as well anyone 18 to 64 years old “at high risk of severe COVID-19” or “with frequent institutional or occupational exposure” to the disease. The approval is slightly different for the Johnson and Johnson vaccination — here, anyone older than 18 can receive a booster shot two months after their initial, single dose.

The FDA also approved getting a different booster than what someone got in their first course of the vaccine. For example, someone who received two doses of the Pfizer vaccine to start could now receive a Moderna booster and someone who received one dose of the Johnson and Johnson could now receive a Pfizer booster.

Booster shots are also likely more relevant for people who received the Johnson & Johnson vaccine initially.

Less consistent protection overall compared to the Moderna and Pfizer vaccines prompted the FDA to recommend a booster dose for all recipients, reports the Associated Press, not just the more at-risk categories.

This applies in any variation — any approved booster can be given to someone who’s already been fully vaccinated by any of the approved vaccines. For those initially vaccinated with Johnson and Johnson, that booster can come at least two months after their first dose, and those vaccinated with Moderna or Pfizer can receive any booster at least six months after their second dose.

Currently, the CDC recommends boosters of the Pfizer vaccine for anyone over 65 and some others 18 years and older at high risk of complications from COVID-19 at least six months after their initial course of Pfizer. The CDC has not yet weighed in recommending the “mix-and-match” method.

Why Might We Want a Booster?

While all of the approved vaccines remain highly effective at preventing infection, severe illness, and death from the coronavirus, there is some evidence that some measures of immunity can fluctuate over time, especially in light of new variants such as Delta. Booster shots are meant to jumpstart immunity in some of the more at-risk groups, as well as those who received the Johnson & Johnson vaccine.

This new mixing strategy comes on the heels of research suggesting that receiving any booster vaccine can boost antibody levels among the fully vaccinated, AP notes. Those who received Johnson and Johnson initially might seriously consider getting a booster dose of either Moderna or Pfizer, too. Recent research has shown that Johnson and Johnson recipients who received a full-strength mRNA booster had a higher antibody response than a second Johnson and Johnson shot, AP reports, adding that the Moderna vaccine was authorized as a half dose.

Assuming final guidance from the CDC follows the FDA’s suggestions, here are the basic takeaways:

  1. Booster doses will now be approved for all three vaccines
  2. For Pfizer and Moderna, boosters will be approved for anyone over age 65, or those 18 and over under certain high-risk conditions
  3. Boosters doses will be approved for all initial recipients of the Johnson and Johnson vaccine
  4. You will be able to get a different vaccine than the one you initially got, and recipients of Johnson and Johnson might want to consider getting a boost of either Pfizer or Moderna

Overall, the most important thing you can do is get vaccinated. The Pfizer vaccine is currently approved for everyone aged 12 and up, and the Moderna and Johnson and Johnson vaccines are approved for everyone aged 18 and up. The CDC notes that all three vaccines are safe and effective at preventing severe illness and death from COVID-19.