MIT Medical answers your COVID-19 questions. Got a question about COVID-19? Send it to us at CovidQ@mit.edu, and we’ll do our best to provide an answer.
I’m a 26-year-old male MIT graduate student who was fully vaccinated with the Pfizer vaccine more than six months ago. I work as a teaching assistant, which requires me to attend in-person classes twice a week and conduct two additional weekly discussion sections with students. The CDC website states that “education staff (e.g. teachers, support staff, daycare workers)” are eligible to get a COVID-19 booster shot. Would a TA like me be considered “education staff” for purposes of vaccine booster eligibility? If so, would I be allowed to receive a booster shot?
As you note, the CDC is allowing boosters for Moderna and Pfizer recipients who are between the ages of 18 and 64, who finished their initial two-shot series more than six months ago, and who “work or live in high-risk settings.” In addition to “education staff,” this category of eligible individuals may include, among others, healthcare workers and first responders, grocery store workers, public transit workers, and workers in food, agriculture, and manufacturing.
And, yes, your teaching assistant (TA) job, however part-time it is, allows you to categorize yourself as “education staff.” In fact, that category includes everyone who works on the MIT campus and has regular contact with students. If you go to get a booster shot, you’ll be asked to self-attest to your eligibility. As long as you declare that you are eligible, you’ll be allowed to get the shot.
But, importantly, according to the CDC, you are someone who may get a booster — emphasis theirs — not someone who should. People who should get a booster include individuals of any age who got a J&J shot more than two months ago, and individuals who completed the two-shot Pfizer or Moderna series more than six months ago and who are residents of long-term care facilities, or older than 65, or aged 50–64 with any underlying medical condition that would increase the risk of severe COVID-19 illness in the event of a breakthrough infection. But since you don’t fall into one of the above categories, you’re part of the booster-optional group. As such, the CDC asks you to carefully consider your “individual risks and benefits” before rolling up your sleeve.
Let’s start by considering your risk of exposure to the virus. According to the CDC, factors that may increase a worker’s risk of exposure include high community transmission, lack of adherence to other prevention measures (like wearing masks), and the likelihood of frequent interactions with possibly unvaccinated people who are not part of one’s own household.
By any of those measures, you have an exceedingly low probability of being exposed to the virus in the course of performing your TA duties. The positive-test rate on campus has remained very low — lower even than the very low positive-test rate in the city of Cambridge. Additionally, MIT has multiple other layers of protection in place. These include indoor masking, enhanced ventilation, social distancing, and a highly vaccinated campus population — 98 percent, at last count.
Since you’re relatively young, healthy, and fully vaccinated, your risk of serious illness is also close to nil. By the CDC’s own analysis of Pfizer boosters, for example, it would take more than 8,700 booster shots in the arms of fully vaccinated 18- to 29-year-olds to prevent just ONE hospitalization. As an excellent recent analysis points out, for males in that age group, like you, a Pfizer booster is more likely to cause hospitalization due to the very rare vaccine side effect of myocarditis than to prevent hospitalization with COVID-19.
How about possible benefits? Since COVID-19 boosters are so new, we can’t say for sure what their long-term benefits might be. Vaccines train the immune system to recognize and fight a specific pathogen — in this case, the SARS-CoV-2 virus — and there’s good evidence that your original vaccination series did this well. If you were to experience a breakthrough infection at this point, your immune system should recognize the virus and start manufacturing the antibodies and T cells your body would need to shut it down. Will a booster enhance this type of immunological memory? If you get a booster now, will your memory B and memory T cells mount an even more efficient response if you’re exposed to the virus in March or April of next year? These are questions we can’t yet answer.
What we do know is that, in the short term, a booster will work the same way as your initial two shots — your antibody level will rise, and then it will decline. That initial increase in antibodies will give you the benefit of better protection against breakthrough infections, but this enhanced protection will be temporary. Data from Israel, for example, showed far fewer breakthrough infections and fewer cases of severe illness for at least 25 days in their first group of booster recipients, people older than 60. But updated data showed this protection waning by the second month.
In some cases, of course, enhanced protection may be very useful, even if it’s relatively short lived. For example, boosters are probably a good idea for young healthcare workers who have repeated exposure to patients who are sick with COVID-19 in an area with high community transmission. While their original vaccinations most likely continue to protect these workers against severe illness, even a mild or asymptomatic breakthrough infection would keep any of them home for 10 days at a time when their healthcare systems are overloaded, under stress, and unable to afford employee absences. It’s in the interest of society, not just the individual, for such workers to have extra protection against infection at times like these.
For a young, healthy teaching assistant at MIT, the risk-benefit analysis is clearly different. In cases like yours, there may be plenty of reasons to wait, according to Associate Medical Director Shawn Ferullo. “Even if a better vaccine doesn’t come along before you need a booster, we have lots of evidence showing that longer intervals between vaccine doses lead to more robust immune responses,” he notes. “And since you are otherwise eligible for a booster, you might want to think of it as an extra layer of protection that you can keep in reserve for a time when you really need it. In other words, you could consider timing a booster shot in order to have the highest possible antibody levels during a time when you anticipate a high risk of exposure or when you most want to avoid the possibility of infection. For example, if you are planning to travel to an area where the vaccination rate is low and community transmission is high, or if you are traveling to visit especially vulnerable family members or friends during the upcoming winter break, you might want to time that booster for two or three weeks before your trip.”
Ferullo thinks that everyone may need a booster eventually, but he doesn’t believe the need is urgent for most otherwise healthy young people. “These amazingly effective vaccines — and, eventually, vaccine boosters — will probably always be our best layer of protection against this virus, but, like many things in life, timing is everything,” he emphasizes. “COVID-19 is not going to disappear. No vaccine will be 100 percent protective against infection, and mild to moderate COVID-19 illnesses will likely be a fact of life going forward. But by following public-health advice on vaccinations, which includes getting boosters only when we really need them, most of us will continue to be well protected against serious illness, and this virus will become something we can live with.”
This news story has not been updated since the date shown. Information contained in this story may be outdated. For current information about MIT Medical’s services, please see relevant areas of the MIT Medical website.