Centers for Disease Control approves ‘mix and match’ of COVID vaccines

The Centers for Disease Control and Prevention recommended on Oct. 21 people need not receive a COVID booster from the same manufacturer that provided the original vaccine. 

WASHINGTON – Adding to the options by which Americans can protect themselves from the COVID-19 pandemic, but also perhaps adding to the public confusion, the Centers for Disease Control and Prevention has announced it is OK to “mix and match” COVID vaccines and boosters.

Rochelle Walensky, CDC director, said on Oct. 21 that those eligible for boosters can get any of the three available injections regardless of which vaccine they first received. The CDC gave its approval on Oct. 20.

With autumn fully entrenched in parts of the U.S., many health experts are recommending boosters, especially for those at elevated risk due to age or health conditions. Due to much restricted movement due to COVID, cases of influenza plummeted during the winter of 2020-21. Some are concerned there may be a twin blitz of flu and COVID this winter.

“These recommendations are another example of our fundamental commitment to protect as many people as possible from COVID-19,” Walensky said in her Oct. 21 statement, released after receiving recommendations from the Advisory Committee on Immunization Practices. “The evidence shows that all three COVID-19 vaccines authorized in the United States are safe – as demonstrated by the over 400 million vaccine doses already given. They are all highly effective in reducing the risk of severe disease, hospitalization, and death, even in the midst of the widely circulating Delta variant.”

A “mix and match” regimen involves subsequent doses of vaccine provided by a different manufacturer than that providing the first. COVID vaccines in the U.S. are provided by Pfizer, Moderna and Johnson & Johnson. 

Walensky’s statement authorized the Johnson & Johnson booster shot for adults 18 and older, to be given at least two months after the first vaccine. Also approved was a half-dose of the Moderna vaccine as a booster to anyone older than 65, those at high risk, those in a group living setting such as a nursing home or assisted living, and workers who can expect frequent exposure, as in the field of health care That booster is available to those at least six months removed from a two-dose regimen of Moderna. A Pfizer booster was approved in September.

Summarizing, for people who received a Pfizer-BioNTech or Moderna COVID-19 vaccine, these groups are currently eligible for a booster shot at six months or more after their initial regimen:

• People 65 and older;

• People 18 and older who live in long-term care settings;

• People 18 and older who have underlying medical conditions; and

• People 18 and older who work or live in high-risk settings.

For those who received the Johnson & Johnson vaccine, booster shots are recommended for people age 18 and older who received the vaccine at least two months ago.

With booster recommendations now in place for all three U.S. vaccines, the CDC is advising that those eligible may choose which booster dose to receive. People may choose to stay with the same vaccine they originally received, or actively seek something different. The CDC suggests talking with a doctor if there is any further question or confusion.

The data gathered on “mix and match” is on a much smaller group than the data showing the efficacy of the vaccines separately, which may lead some to stay with their first vaccine. But mixing and matching also allows flexibility where vaccines from one company may not be as readily available.

The mix and match data suggests the greatest benefit to those who first received the Johnson & Johnson vaccine.

The American Medical Association released a statement supporting the “mix and match” practice authorized by the CDC.

“We believe the FDA’s authorization and the CDC’s recommendations in support of booster doses, including the flexibility to mix-and-match products, will help provide continued protection against COVID-19 for those who need it most,” said Dr. Susan R. Bailey, AMA immediate past president. “The balance of benefits and risks for booster doses varies, and we encourage those who have questions to reach out to their physician or vaccine provider. The scientific evidence is clear that the vaccines against COVID-19 are safe and remain effective in preventing hospitalization and severe disease. We continue to strongly urge everyone who has not yet been vaccinated against COVID-19 and is eligible, including pregnant people, to get vaccinated as soon as possible to protect themselves and their loved ones. We also encourage the public to continue taking evidence-based public health measures, such as physical distancing and wearing face masks, to help protect those not yet eligible for vaccination.”