Mix-and-Match COVID Vaccine Boosters Are Here

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CHARLOTTE – Millions of people who are newly eligible for a COVID-19 booster will have the option to choose which vaccine they receive.

The “mix and match” approach, approved by the Centers for Disease Control and Prevention (CDC), gives booster-eligible people the ability to get a different COVID vaccine than their initial series. Some people may prefer the vaccine type they received originally, while others may choose to get a different booster.

Health officials in many states had been asking the federal government for that flexibility because of potential supply complications and to keep distribution as easy as possible.

The updated CDC guidance followed emergency use authorizations (EUA) to make COVID boosters eligible for both Moderna and Johnson & Johnson. Pfizer’s vaccine was the first to receive EUA for its booster shot.

Which booster is right for you?

Dr. David Priest

The simple answer is the one that’s most readily available. Getting any of the three shots now is better than waiting, said Dr. David Priest, Novant Health chief safety, quality and epidemiology officer.

“It’s important to remember no matter what product you get, you will have a boost in immune response,” Priest said.

Evidence shows all three vaccines are safe and highly effective in reducing the risk of severe disease, hospitalization and death. Getting vaccinated is the best way to protect yourself and reduce the spread of the virus – even if you’ve had COVID.

But if you have a choice, here’s what to keep in mind:

  • If you had an mRNA vaccine — Pfizer or Moderna — Priest advised people to stick with the same product. “I don’t think there’s much benefit in mixing and matching Moderna and Pfizer right now,” he said. But if one is not available when you go for your booster, then go ahead and get the other mRNA option, he added.
  • There is a benefit in getting an mRNA booster if you received the J&J vaccine, Priest said. Studies have shown that Pfizer and Moderna boosters induced higher levels of antibodies in J&J recipients than a second J&J dose. At the same time, he added, “If you want to get a second J&J dose, I think you’re going to have reasonable protection, as well.”
  • If you had an adverse reaction to one type of vaccine, “you could boost with another. Talk with your medical provider as you decide,” said Aliza Hekman, a Novant Health physician assistant who specializes in infectious disease.

Is the booster different from what I already got?

The only thing that would vary is the dosage.

  • Pfizer’s booster is the same dosage as their original vaccine: .3 millileters.
  • J&J’s booster is the same dosage as its original vaccine: 0.5 milliliters.
  • Moderna’s booster is .25 milliliters – half the dosage of its original vaccine.

Moderna has said it lowered its booster dosage to increase its vaccine availability worldwide, while lessening the severity of side effects such as fever, chills, fatigue and headache. While uncomfortable, these expected effects are generally a good sign your booster is working as intended by building COVID antibodies.

Boosters are strongly recommended for certain groups

Data shows people who are 65 and older need a booster more than any other group, Priest said. “The small number of people who are vaccinated and have to be admitted to the hospital are generally over the age of 65. They were vaccinated early in the pandemic and often have other medical issues.”

People who are “profoundly immunosuppressed” are also strongly encouraged to get a booster dose. The COVID death of retired Gen. Colin Powell, who had cancer, highlights the importance of boosters, doctors agree. Powell had made an appointment to get a booster then fell ill before he got the shot.

“If you’ve had an organ transplant, are receiving chemotherapy or living with uncontrolled HIV, the booster is even more important because you generally don’t respond to vaccines in the same way,” Priest said.


The following groups are eligible at least six months after their second dose:

  • People 65 and older.
  • Age 18+ who are at high risk of severe COVID.
  • Age 18+ who live or work in high-risk settings.

Johnson & Johnson

The following groups are eligible at least two months after their first dose:

  • Anyone who is at least 18 years old.


The following groups are eligible at least six months after their second dose:

  • People 65 and older.
  • Age 18+ who live in long-term care settings.
  • Age 18+ who have underlying medical conditions.
  • Age 18+ who live or work in high-risk settings

How to Schedule: Anyone seeking a booster dose is asked to schedule an appointment. You don’t need to be a Novant Health patient to schedule. And keep in mind, all COVID vaccines are free – even if you do not have insurance.

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