Gen. Colin Powell , the first Black U.S. secretary of state, passed away this week due to COVID complications. Yes, Powell was fully vaccinated but immunocompromised. However, he had scheduled the booster but was too ill to receive it.

After President Joe Biden received his COVID-19 booster, many wondered if they needed a booster too.

I have been a registered nurse for over 38 years, and the message we are receiving is confusing, even to me. If it is confusing to me, it might be confusing to you. After the death of Gen. Powell, the rush is on. Some people were posting links, via social media, to where they could receive the COVID-19 booster. A family member was trolling the pharmacy websites for the vaccine as her life depended on it.

Three of the vaccinations (Pfizer-BioNTech, Moderna, and Johnson & Johnson) used in the U.S. have been given the green light by the Food and Drug Association and Center. Still, many people in my world, friends, family, co-workers, and students ask: Who should get the booster shot?

Booster shots present a moral dilemma. Why should some populations get the third shoot when others have gotten just one or none?

In a report from the European Centre for Disease Prevention and Control, only one-third of adults in the E.U. and European Economic Area have not received both doses of the COVID-19 vaccine. It feels like “the haves and have nots.” Wealthy countries like the U.S., United Arab Emirates, China, Japan, France, and the United Kingdom have 65% to 95% vaccination rates. However, developing countries like the Philippines, Bangladesh, Egypt, Ethiopia, and Nigeria have 25 to 2.4% vaccination rates. The goal for recovering from the COVID-19 pandemic is herd immunity. Per the Mayo clinic, it would take 70% of the population to reach herd immunity.

Additionally, the FDA has authorized the minimum age for the vaccine to 12 years old for the Pfizer shoot. The Biden administration is planning to have pediatric-friendly facilities to administer immunizations after getting approval from the FDA. For children from 12-17, only 42% received one dose, and 32% completed the series. We need to protect children, one of the most vulnerable populations, to reduce COVID-19–associated morbidity and mortality rates. As adults, we need to do whatever we can to facilitate the safer reopening of schools for in-person learning.

In the U.S., we have not reached herd immunity. According to the CDC, there has been a significantly increased risk of COVID-19 illness and death for people who remain unvaccinated, especially the 12- to 64-year-olds. Only 66% of the population has received one dose, 57% of the people in the U.S. are fully vaccinated.

Of adults aged 65 and older, 84% are fully vaccinated. Unfortunately, there were more COVID-19 deaths among older adults during the Delta surge in states with the lowest vaccination rates. If the vaccination rate in the least vaccinated states had been the same as the vaccination rate in the most immunized states, it was predicted there would be a 61.7% reduction from the actual number of deaths.

The Black and Hispanic/Latinx population are less likely than their white counterparts to have received COVID vaccines. The gap is narrowing, but the population remains vulnerable to increased risk, mainly as the variant spreads.

Family and friends asked me: Does the death of Powell make it more urgent that I need the booster shoot?

Before you run to the pharmacy or public health websites to sign up for the COVID booster, there are a few things to consider.

Powell was a prime candidate because he was at high risk due to his age and underlying Parkinson’s and cancer conditions. He was battling multiple myeloma, a cancer of the white blood cells found in the bone marrow that suppress the body’s immune response. This disease weakens the body’s immune system by causing severe anemia and lower platelets cells which interferes with the body’s ability to fight the COVID-19 infection. Additionally, it has been reported that only 45% of people with multiple myeloma have an adequate antibody response from the COVID-19 vaccine.

Those over 65 with health issues and at risk due to work are encouraged to get the boosters first. This includes 18-64 with an autoimmune condition or underlying medical condition or employment considered that put you at risk.

Fully vaccinated individuals in the general population are not in urgent need of a booster shot. If you do not fit the criteria for age, underlying condition, or do not work in a high-risk environment, consider waiting at least eight months.

Putting off your booster could ease the burden for the supply of vaccines and related supplies. Most importantly, consult your healthcare provider or public health office. Whatever choice you make, consider the facts and what is safe for you, your family, and your community.

Denise Dawkins is a nurse.

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