Logan Reed
The COVID-19 pandemic has brought to light several discussions about vaccines, including whether both shots have to be the same. While the majority of vaccinated people received two shots of the same vaccine, some people have received two different vaccines for their first and second doses. This is known as a mix-and-match approach. The idea of mixing and matching vaccines was first teased by the FDA and CDC in October 2023, and it was later approved for booster shots. This approach has been deemed safe and effective by health organizations and studies in various countries, including Canada, Sweden, Britain, Finland, France, Norway, South Korea, and Russia.
Characteristics and Values:
| Characteristics | Values |
|---|---|
| Can you get a flu shot and a COVID-19 vaccine at the same time? | Yes, it is safe to get a flu shot and a COVID-19 vaccine or booster at the same time. |
| Do you have to get them at the same time? | No, you can receive them on different days without regard to timing. |
| Where can you get the shots? | In the same arm or different arms, with injection sites at least 1 inch apart. |
| Who can get the COVID-19 vaccine? | Everyone ages 6 months and older. |
| Who should get a third shot? | Immunocompromised people should get a third shot about one month after their first two doses of mRNA vaccines. |
| Who should get a booster shot? | Booster shots are for everyone else. |
| How long should healthy vaccinated people wait to get a booster shot? | Wait two months after a J & J vaccine, five months after the second dose of Pfizer, and six months after the second dose of Moderna. |
| Do booster shots have to be the same brand as the initial vaccine shots? | No, the CDC allows for mix-and-match dosing for booster shots. |
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What You'll Learn
Flu and COVID-19 vaccines can be taken together
It is safe to get the flu and COVID-19 vaccines or booster shots at the same time. However, some vaccine clinics only offer COVID-19 vaccines, so you may need to schedule a flu shot separately. It is recommended to get your flu shot annually by the end of October, but getting vaccinated even after October can still be beneficial.
If you have never received a COVID-19 vaccine before, you do not need to wait to get the flu shot. However, if you have recently received a COVID-19 vaccine dose, you may be advised to delay getting the updated vaccine until you are eligible. Similarly, if you have recently had COVID-19, your healthcare provider may suggest waiting three months before getting the updated vaccine.
If you are eligible for both vaccines, the CDC advises that you can get them simultaneously. The main benefit of getting a COVID-19 vaccine and a flu shot at the same time is convenience. By getting both vaccines together, you save yourself an extra trip to get the second vaccine. Studies have shown that getting the COVID-19 vaccine and flu shot together is safe, but there is no definitive evidence that the effectiveness of either vaccine is boosted by this timing.
You can get the COVID-19 vaccine and flu shot in the same arm or different arms, depending on your preference. The injection sites just need to be at least one inch apart.
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COVID-19 booster shots can be a different brand
It is safe to get a COVID-19 booster shot even if it is of a different brand than your previous vaccine shots. In fact, it is common for some vaccines to diminish in their effectiveness over time, and getting a booster shot can bring the immune system back to robust levels. This is why the CDC recommends a 2024-2025 COVID-19 vaccine for most adults aged 18 years and older, including those who have already been vaccinated or had COVID-19.
The Pfizer-BioNTech vaccine (brand name: Comirnaty) was granted full FDA approval in August 2021 for people aged 16 and older. Moderna's vaccine (brand name: Spikevax) was granted full approval for people 18 and older in January 2022. Both vaccines have been updated over time to target new virus variants. The Novavax vaccine (brand name: Nuvaxovid) is the only non-mRNA updated COVID vaccine available in the US.
For the 2025-2026 season, vaccine manufacturers are expected to update their formulas to target the JN.1 variant. Moderna, Pfizer/BioNTech, and Novavax are expected to target strains related to the JN.1 variant. However, the specific subvariant that will be chosen is uncertain, as it is not yet known which strain will be dominant by the fall.
It is important to note that the Johnson & Johnson (Janssen) COVID-19 vaccine expired as of May 6, 2023, and is no longer available in the US. Those who received the J&J shot are considered up-to-date if they follow the recommendations for getting one of the currently available updated vaccines.
Additionally, it is safe to get a flu shot and a COVID-19 vaccine or booster at the same time, providing added convenience and protection against both illnesses.
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Immunocompromised people may need a third shot
While the initial COVID-19 vaccine series involves multiple doses, immunocompromised people may require additional shots beyond the standard regimen. Immunocompromised individuals are defined as those undergoing treatment with immunosuppressive medications or those with specific conditions that hinder antibody production, such as cancer, rheumatoid arthritis, lupus, or prior organ or bone marrow transplants. For this vulnerable group, studies have shown that the immune response to COVID-19 vaccines may be diminished, increasing the likelihood of breakthrough infections.
To address this concern, a third shot is now considered the standard initial dose for immunocompromised individuals. This additional dose is recommended to be administered about a month after the first two doses of mRNA vaccines like Pfizer and Moderna. The CDC has not yet advised this approach, but other countries like Israel and France are already recommending supplementary doses. Some immunocompromised individuals have proactively sought out these extra doses, and research has indicated an enhanced immune response in some patients.
However, the decision to administer a third shot involves a delicate balance between improving immune response and considering the potential risks associated with additional vaccination. Furthermore, the question of antibody levels necessary for adequate protection remains under investigation. While federal health agencies continue to monitor data on the need for an extra COVID-19 vaccine dose for immunocompromised patients, these individuals and their families must grapple with the challenges posed by rising COVID-19 cases and adjust their daily lives accordingly.
It is worth noting that, in addition to COVID-19 vaccines, immunocompromised individuals may also benefit from annual flu shots. Healthcare providers recommend receiving the flu vaccine by the end of October each year, and it is safe and convenient to get the COVID-19 vaccine and flu shot simultaneously. This dual protection is particularly important for immunocompromised people, as it safeguards them against serious illness from both types of infections.
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Mixing vaccines may increase side effects
While mixing vaccines may provide longer-lasting immunity, early findings from a study by the University of Oxford suggest that it may also lead to an increase in mild to moderate side effects. The study, which tested the mix-and-match approach with the Pfizer and AstraZeneca vaccines, found that participants who received mixed doses reported more short-lived side effects, including fatigue, headaches, chills, feverishness, and muscle pain.
The researchers noted that the side effects were mild and that there were no safety issues. However, they also suggested that mixed dose schedules could result in an increase in work absences the day after immunization. The study is ongoing, and researchers are yet to determine the impact of mixed schedules on immunogenicity, or how effectively the mixed doses induce an immune response.
The concept of mix-and-match vaccines is not new and has previously been used in a clinical trial for an Ebola vaccine. In the context of COVID-19, mixing vaccines may provide longer-lasting immunity, produce a stronger immune response, and better protect against highly infectious variants. It could also simplify vaccine rollouts and increase flexibility in vaccine delivery, especially in low- and middle-income countries facing vaccine scarcity.
While the early findings suggest a potential increase in side effects, further studies are needed to confirm these results and understand the impact on immunogenicity. The mix-and-match approach has been considered in several countries, and researchers emphasize the importance of informing the public about these findings, especially as mixed-dose schedules are already being implemented in some places.
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Countries have different recommendations
Different countries have varying recommendations for vaccine shots, with factors such as demographics, budget, and local health threats influencing their decisions. For instance, the US and UK have distinct approaches to vaccinating against hepatitis A and meningococcal disease. The US recommends the hepatitis A vaccine for infants due to higher case rates, while the UK starts vaccinating against meningococcal disease in infancy due to historically higher meningitis rates.
The US and Europe also differ in their vaccination strategies. The US strategy includes universal flu vaccine recommendations, which lower the burden of respiratory disease, and hepatitis B vaccines for all newborns to ensure protection even if their mothers haven't been tested for the virus. In contrast, many European countries only vaccinate high-risk newborns against hepatitis B. The US approach also considers the community-wide benefits of vaccinations, which can reduce transmission and parental time off work.
Denmark has a more minimalist approach, with a vaccination schedule targeting 10 diseases compared to the US's 18. Anders Hviid, an epidemiologist, emphasizes that Denmark's approach focuses on the most severe and life-threatening conditions, and all vaccines are voluntary. However, he cautions against directly comparing Denmark's healthcare system and situation with that of the US.
During the COVID-19 pandemic, countries like Canada, Sweden, Britain, Finland, France, Norway, South Korea, and Russia considered mixing and matching vaccine doses. Canada's vaccination committee deemed it safe to pair AstraZeneca's COVID-19 shot with a second dose of Pfizer or Moderna. Sweden, Britain, Finland, and France recommended offering a different vaccine for the second dose to individuals under a certain age who received AstraZeneca's vaccine first.
In late October 2023, the CDC and FDA in the US approved mix-and-match vaccines for booster shots, providing recommendations for all three available COVID-19 vaccines in the country. Individuals can choose their booster vaccine, with studies indicating that Moderna and Pfizer boosters offer better protection than Johnson & Johnson's.
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