Whether you were vaxxed once against COVID-19 (77% of Americans), double-vaxxed (65%), or double-vaxxed and boosted (29%), chances are you’re fed up with being poked and prodded. With the recent news of a fourth vaccine, you may be wondering if you need yet another shot.

On March 15, Pfizer requested emergency use authorization to the Food and Drug Administration to make a second booster shot mRNA vaccine against COVID available to adults over the age of 65. Two days later, Moderna submitted a more expansive request for their mRNA vaccine, including all adults over the age of 18.

The Food and Drug Administration on Tuesday authorized an extra dose of the Pfizer or Moderna vaccine for Americans 50 and older and for certain younger people with severely weakened immune systems.

The Centers for Disease Control and Prevention later recommended the extra shot as an option but stopped short of urging that those eligible rush out and get it right away.

We asked doctors to weigh in on COVID-19 boosters.

Do I need a second booster?

The most important thing you can do is complete the initial 2-shot vaccine series followed by your first booster, says Robert Glatter, MD, an emergency medicine physician at Lenox Hill Hospital in New York.

“Based on all studies thus far, receiving a booster has consistently provided the best protection against developing severe disease, hospitalization, and death. People who are boosted have remained at the lowest risk for adverse outcomes overall,” says Dr. Glatter. On the flip side, those eligible for a booster who haven’t received one are at elevated risk for a breakthrough or reinfection, he says.

People over the age of 65 and those who are immunocompromised, such as cancer patients, those undergoing chemotherapy or immunotherapy, people with autoimmune disorders, and organ transplant recipients, should be first in line to receive a second booster, Glatter says .

“Others with recent breakthrough infections who have underlying cardiac disease, kidney disease, or chronic lung disease should also receive an additional booster shot for added protection,” says Glatter.

A second booster may be warranted in the general population as well. That’s because the mRNA vaccines’ protection against infection from COVID typically wanes or diminishes within several months across all age groups.

“Two or three vaccinations will protect the majority of people from serious disease. But the reality is that they are not very effective at preventing infection — which is generally mild or asymptomatic — after three or four months,” says Glatter.

I’ve been boosted and had omicron. Do I really need to be boosted again?

Does infection with a recent variant after being double-vaxxed and boosted enhance immunity against COVID? The jury’s still out on that one, says Glatter.

“It’s unclear if healthy persons who are fully vaccinated and received a booster shot but developed a breakthrough infection (most likely with omicron) without developing severe disease or requiring hospitalization will ultimately require a second booster,” Glatter says. Further research is needed.

What’s more, your level of immunity against COVID depends on when you came down with the virus or received the vaccine, says Serhat Gumrukcu, MD, an epidemiologist, and executive director and director of translational research at Seraph Research Institute in Los Angeles, Calif.

The more the virus moves from one person to another, the more it mutates and changes, making it less responsive to the vaccine, Dr. Gumrukcu explains. All of the vaccines we have today were based on the original COVID variant, which has changed quite a bit over the last two years, he says.

“With the delta and omicron variants, the vaccine’s efficacy dropped significantly. It prevented severe disease, but it didn’t prevent infections. It didn’t prevent transmission,” says Gumrukcu.

If you had omicron, you likely developed a degree of immunity that will provide some protection against a new variant, like BA.2. But over time, that immunity will decrease, says Gumrukcu.

Will the COVID vaccine become a yearly immunization like the flu shot?

The flu virus changes every year, so we have an annual vaccination to try to stay ahead of it, says Gumrukcu. If you’ve had a particular strain of the flu, or been vaccinated against that strain, your immune system will recognize it if it’s exposed to the same strain in the future, he explains — but COVID is different.

“We don’t know how yet, but COVID does something to our immune system that causes it to forget the virus eventually. Our immune system somehow gets reset. So you can actually get infected by the exact same variant one or two years after you were infected the first time,” Gumrukcu says.

He anticipates an ongoing need for boosters. “We will probably need a shot possible once a year, maybe even twice a year – that is my prediction,” Gumrukcu says.

Glatter agrees. “The reality is that we are almost certainly going to need another booster. This issue is ultimately the timing and for which specific variant. That’s really the holy grail at this point in time.”