Getting a COVID-19 booster dose restores the vaccine effectiveness

About vaccines and boosters and why they are important. What is a booster shot and what does it mean?

It is very important that people keep up vaccination after their first (primary) vaccine, to include additional (booster) doses where available. The booster dose helps people maintain strong protection from severe coronavirus disease. These booster doses are available to all persons, aged 18 years and older. 

Individuals who have received one dose of the J&J vaccine will be eligible to receive a booster dose of the J&J vaccine after an interval of at least two months (60 days).  Individuals who have received two primary doses of the Pfizer vaccine will be eligible to receive a booster dose of the Pfizer vaccine after an interval of at least six months (180 days).  

It is given after the protection provided by the original shot(s) has begun to decrease over time. The booster helps people maintain strong protection from severe coronavirus disease. Research has shown that over time the protection against infection, and to a lesser degree severe disease, may drop to below satisfactory levels. This is when booster doses are recommended. It will also increase immunity against possible new variants.

Immunocompromised individuals who have completed their primary vaccine regimen, will become eligible to receive a booster dose of J&J two months after having received the first dose, or a booster dose of Pfizer six months after having received the second dose.

It is understandable that people may have safety concerns about taking up any vaccine. After getting vaccinated for COVID-19, you may well experience some temporary symptoms like those you might notice when you get a flu shot, such as a sore, swollen arm where you got the shot. You might run a fever and experience body aches, headaches, and tiredness for a day or two. Chills and swollen lymph nodes can also occur. While these symptoms are inconvenient and mildly unpleasant, they do not mean you are sick, and are actually a good thing, as they signal that your immune system is responding to the shots and building up protection against the coronavirus. It is far better to experience some mild and inconvenient symptoms following vaccination, than to run the risk of having severe COVID-19 disease.

At the end of January 2022, 77 615 people in the province have already taken up their booster dose since it became available late December 2021. If we work together, we can boost our protection and keep each other safe. 

We again call on everyone eligible for their booster dose to take up this opportunity as we have now exited the fourth wave and are in a good position to ensure we get as much protection against further waves and variants.

Where can I get a COVID-19 vaccine booster?

The Department regularly publishes its weekly vaccination sites on its social media pages. In addition, there are several outreaches happening in communities to take vaccines closer to them. Be on the lookout and speak to your local health teams on these outreaches.

How will I know I should get a booster or when to get it?

As with all others who registered, you can expect a reminder-SMS when you need to go for your booster dose. However, you do not have to wait for this SMS and can simply go to a vaccination site once the waiting period has lapsed - at least two months (60 days) after receiving the J&J or at least six months (180 days) after receiving your second Pfizer vaccine. You will receive a booster dose of the same vaccine as your primary regimen.   

Evidence of waning protection from primary vaccination series – World Health Organisation

In the Western Cape, the risk of COVID-19 infection and especially severe disease is much higher in unvaccinated compared to vaccinated people. If breakthrough infections occur in vaccinated persons, in most cases they are less severe than those in unvaccinated persons. Even during the Omicron wave, the risk of death in breakthrough cases in the Western Cape was nearly four times lower than in unvaccinated cases, and the risk of all hospital admissions in unvaccinated cases was twice as high as vaccinated cases.  However, emerging data consistently show a decline in vaccine effectiveness (called “waning of immunity”) against COVID-19 infection and more significant decline in older adults.

The degree of waning of immunity differs between vaccine products and target populations. The protection provided by vaccines and the extent of waning will depend on a number of factors, including circulating viruses (in particular variants of concern), prior infection at the time of primary vaccination, and the primary vaccination schedule used.

Frequently asked questions – National Institute for Communicable Diseases 

1. Why should I get vaccinated if the vaccine already needs a booster shot to protect me? Are vaccines not effective?

Vaccines have been shown in controlled trials and in the evaluation of national vaccination programmes (e.g. United Kingdom) to reduce severe disease and mortality by up to 95-97%. This lifesaving effect has continued, even as variants have emerged. Taking a vaccine will protect you and your loved ones from a devastating illness and/or death. Recently, vaccines have also been shown to reduce transmission of COVID-19 from one person to another. As early as the first clinical trials, vaccines have been shown to reduce but not prevent mild to moderate illness.

As COVID variants have emerged, laboratory research has shown that protection against COVID-19 infection is related to antibody levels. Booster vaccination with the J&J or Pfizer vaccine is a reliable and safe way of increasing antibody levels.

2. Why are booster shots recommended?

Booster vaccination increases antibody levels and ‘T-cell responses’ to COVID-19. Laboratory testing has shown that high antibody levels are more effective at neutralising variants of COVID-19. Therefore, booster vaccines are helpful to improve protection from infection.

3. Are booster shots safe?

Side effects of booster vaccines are like side effects from a first vaccine. Common side effects include tiredness, body aches, and pains, low-grade fever, pain at the injection site. Persons who have a booster vaccine may experience these common side effects more frequently. These side effects resolve completely within 24-48 hours.

4. Can you mix and match vaccines?

Presently in South Africa, SAHPRA has not licensed mix-and-match vaccines. However, there is good evidence that mix-and-match vaccines are just as effective (and sometimes better) at increasing antibody levels. SAHRPA has requested submission of evidence to support a ‘mix-and-match’ approach, so watch their website for updates.

5. Will a booster help against Omicron?

Yes. There is good evidence that booster vaccination increases antibody levels to the spike protein of the SARS-CoV-2 virus and that higher antibody levels offer more protection against variants, including Omicron.

6. What if I’m immunocompromised, does the timing of the second/third shot differ?

Persons who are immunocompromised should receive an additional Pfizer or Johnson and Johnson vaccine dose at least 28 days after receiving their last dose. Persons who are immunocompromised should be referred by their doctor for a booster dose. The doctor should provide a letter and this should be shown at the vaccination site.

Presently, persons are considered immunocompromised if they have

• Haematological or immune malignancy
• Moderate to Severe Primary immunodeficiency disorder
• HIV infection with CD4 count < 200 cells/µL within the last 6 months
• Asplenia
• Individuals receiving the following treatments:
  • High dose steroids or systemic biologics (e.g. for autoimmune conditions)
  • Long term renal dialysis
  • Transplant recipients (Solid organ or bone marrow)

The additional vaccine dose should be of the same vaccine type as the initial dose (or doses).

Notes:

Primary vaccine = the first (initial) vaccine dose

Second dose = to complete the primary regimen (in case of Pfizer)

Booster dose = an additional vaccine after the initial vaccine regimen is complete (third Pfizer or second J&J)