ATAGI recommends an additional booster dose of COVID-19 vaccine to increase vaccine protection before winter for selected population groups (see Table 1) who are at greatest risk of severe illness from COVID-19 and who have received their primary vaccination and first booster dose. These groups are:
- Adults aged 65 years and older
- Residents of aged care or disability care facilities
- People aged 16 years and older with severe immunocompromise (as defined in the ATAGI statement on the use of a 3rd primary dose of COVID-19 vaccine in individuals who are severely immunocompromised)
- Aboriginal and Torres Strait Islander people aged 50 years and older.
The additional winter booster dose can be given from 4 months or longer after the person has received their first booster dose, or from 4 months after a confirmed SARS-CoV-2 infection, if infection occurred since the person’s first COVID-19 booster dose.
ATAGI recommends that the rollout of the additional booster dose for these groups starts from April 2022, coinciding with the rollout of the 2022 influenza vaccination program.
Influenza vaccine can be co-administered with the additional booster dose of COVID-19 vaccine. However, if a person is not yet eligible for their additional booster dose, influenza vaccine could be given ahead of the additional booster dose.
Comirnaty (Pfizer) or Spikevax (Moderna) are the preferred vaccines for COVID-19 booster doses including the additional winter booster dose. Vaxzevria (AstraZeneca) can be used when an mRNA vaccine is contraindicated or a person declines vaccination with an mRNA vaccine. Nuvaxovid (Novavax) can be used if no other COVID-19 vaccine is considered suitable for that person.
For other groups not listed above, there is insufficient evidence of the benefits of an additional booster dose to make recommendations at this time. This includes people younger than 65 years with medical conditions that may increase their risk of COVID-19, individuals with disability and National Disability Insurance Scheme (NDIS) recipients who are not in residential disability care, Aboriginal and Torres Strait Islander people aged 16 to 49, workers at health care or residential care facilities, or younger healthy adults. ATAGI will continue to monitor emerging evidence and may recommend an additional dose for these groups in the future.
Prevention of severe illness from COVID-19 remains the primary goal of the ongoing COVID-19 vaccination program. These recommendations for an additional booster dose focus on protecting the most vulnerable groups against severe disease and reducing the potential burden on the healthcare system over the coming months.
The secondary aims of the COVID-19 vaccination program are preventing infection and preventing transmission of the virus. There is limited evidence at this stage for additional booster doses to prevent transmission. Emerging evidence in relation to prevention of transmission by vaccination will continue to be monitored and additional booster doses may be recommended in additional groups in the future.
All people aged 16 years and older are recommended to receive a first booster dose of COVID-19 vaccine after completing their primary course. For most people, this will be a third dose. The booster dose is important to maintain protection against COVID-19.
For any person aged 16 and older who has not received their first booster yet, ATAGI recommends they receive it as soon as possible.
Protection against infection wanes after the first booster dose. However, protection against severe disease (rather than all infection) is relatively well maintained, especially in young healthy populations.