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Hawaii News | Kokua Line

Kokua Line: What are the rules for the booster shots?

Question: I thought the boosters were already approved a while ago — my friend got one — but now all I ever hear them talk about is the Pfizer shot. What if I got Moderna?

Answer: Your question highlights the important distinction between a “third dose” for immunosuppressed people who did not mount a strong antibody response after two doses of either the Pfizer or Moderna COVID- 19 vaccines, and the new “booster shots” authorized Friday for a much broader swath of the population who received the Pfizer vaccine at least six months ago, the U.S. Centers for Disease Control and Prevention explains.

A “third dose” has been available since mid- August, and remains so, for moderately to severely immunocompromised people who received their second dose of an mRNA vaccine (Pfizer or Moderna) at least four weeks prior. This category includes people with weakened immune systems due to an organ or stem-cell transplant or cancer treatment, to name a few examples. Read details about eligibility on the CDC website, at

About 14,000 people in Hawaii had received a “third dose” of Pfizer or Moderna COVID-19 vaccines as of Thursday, according to the state’s COVID-19 portal, before the CDC authorized the broader Pfizer “booster shots” on Friday.

By contrast, the new “booster shots” are for people who received the Pfizer vaccine at least six months ago and meet certain age, health, work or residence criteria that put them at higher risk of a breakthrough case of the delta variant (see details below), according to the CDC.

So, if you are immunocompromised according to the CDC’s guidelines, you may get a “third dose” of Moderna now. But if you are not, and want a “booster shot” to offset potentially waning immunity many months after being vaccinated, you’ll have to wait until a Moderna booster is approved.

Q: When will that be?

A: That’s unclear. The CDC indicates it will be sooner rather than later and that Moderna and Johnson & Johnson booster shots likely will be recommended for the same categories of people now eligible for the Pfizer booster.

To answer other readers, no, mixing and matching booster shots is not recommended.

“Providing a Pfizer booster dose to those who received the Moderna or Johnson & Johnson vaccine is not authorized or recommended at this time,” Hawaii’s Health Department said in a news release.

Q: Who can get the Pfizer booster approved Friday?

A: People 65 and older, residents in long-term care settings, and people age 50 to 64 with underlying medical conditions should get the booster, the CDC says, while people 18 to 49 with underlying medical conditions, and people ages 18 to 64 at higher risk of catching COVID-19 because of where they work or live may choose to do so. The CDC distinguishes between “should” and “may” in the recommendations, which apply only to individuals who received the second dose of their Pfizer vaccine at least six months ago. Read details at

Hawaii’s Health Department is generally following the CDC’s recommendations but says getting people fully vaccinated against COVID-19 is more urgent than dispensing booster shots. Individuals ages 12 and up who haven’t received their first or second dose are urged to do so and remain the department’s top priority in Hawaii’s COVID-19 vaccination campaign.

Q: What are the underlying conditions?

A: The CDC lists conditions that increase the risk of severe COVID-19, including diabetes, obesity, chronic lung diseases, cancer, heart failure, kidney disease, smoking, substance abuse and numerous others. Being pregnant also raises the risk of severe disease. See the full list at

Q: Will I have to bring a doctor’s note to prove I’m eligible for a booster?

A: No, the CDC calls for self-attestation. You should bring your CDC card to confirm you received the Pfizer vaccine, as well as your ID and insurance card if available.

Q: Where can I get a booster shot?

A: Go to to find locations statewide. Some providers use a screening tool that makes it simple to indicate whether you need a first dose, second dose, third dose (Moderna or Pfizer, for the immunocompromised) or booster shot (third Pfizer dose, not immunocompromised.) Walk-ins may be allowed at some sites.

Also, people who are 65 or older may call 2-1-1 for help scheduling an appointment. People who cannot make it to a vaccination site may call 586-8332 or 1-833-711-0645 to have the shot brought to them, the DOH says.

Q: Will Hawaii have enough Pfizer vaccine to accommodate these new booster shots as well as first doses for children ages 5 to 11, since that age group is expected to be approved for COVID-19 vaccination fairly soon?

A: It’s impossible to say since COVID-19 vaccination is not yet approved for that age group. Estimates for when approval might come range from around Halloween to the end of this year. The state’s vaccine supplies are replenished regularly.

Children able to receive their first dose of Pfizer’s COVID-19 vaccine would be prioritized over adults eligible for booster shots, DOH Director Libby Char said Friday, in keeping with the state’s intent to prioritize baseline COVID-19 vaccination over booster shots if shortages occur.

Write to Kokua Line at Honolulu Star-Advertiser, 7 Waterfront Plaza, Suite 210, 500 Ala Moana Blvd., Honolulu 96813; call 529-4773; fax 529-4750; or email

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