Japan plans to allow COVID-19 booster shots for anyone who has received two vaccination doses — a stark contrast to other countries offering them only to older people and those with pre-existing conditions.

Tokyo had initially considered giving booster shots only to front-line health workers and older people. But a health ministry panel on Thursday decided that everyone who has had two shots will be eligible, given that research overseas has shown that vaccine efficacy declines to around 50% over a few months.

The panel did not reach a conclusion on whether people will be allowed to mix shots for the booster, for example receiving the Pfizer vaccine after being given Moderna for the first two doses.

The health ministry cited U.S. research published in the Lancet earlier in October that said vaccine effectiveness against infection declined from 88% during the first month following vaccination to 47% after five months for all age groups.

For ages 16 to 44, the figure declined from 89% to 39%, while those age between 45 and 64 saw a fall from 87% to 50%. For those 65 and over, it was from 80% to 43%, the study showed.

In the same study, however, protection against hospitalization remained high at 88% after five months, up from 87% in the first month after being fully vaccinated.

The government plans to start giving booster shots to front-line workers from December, and next year for other people. Those who have gone at least eight months since they received their second dose will be eligible for a booster shot.

Other countries have so far limited booster shots according to age group. The United States and France have said they will administer the shots to those age 65 and older, in addition to health care workers and those with underlying conditions. U.S. President Joe Biden, 78, received a booster shot in late September.

In the United Kingdom, the cutoff age is currently 50 years and older.

Israel, meanwhile, is administering booster shots to people age 12 and older, having lowered the age from the initial target of 60 years and over. Singapore has also lowered the age from 60 and over to 30 and above.

Booster shots in general have been a controversial issue worldwide, with the World Health Organization stating that administering the initial round of shots to countries where the vaccination rate is low should be the priority.

“Improving coverage of the primary vaccination series should be prioritized over booster vaccination,” the WHO said in a statement.

Only 3.1% of those in low-income countries have received at least one dose of the vaccine, according to Our World in Data. In Japan, 71.2% of the population was fully vaccinated as of Friday.

A further question is whether booster shots will be needed on a regular basis. Moderna Inc. CEO Staphane Bancel says they will.

In an interview with Reuters on Wednesday, Bancel said he expects that people over age 50 will need annual COVID-19 booster shots starting in 2023 because protection against the coronavirus wanes over time.

“I could see a world where from 2023 everyone ages 50 and above is boosting every year,” Bancel said. “It’s a population that drives hospitalizations and way too many deaths.”

But other experts have said they do not see a need for a booster yet, arguing that the vaccines are still working well enough to prevent serious illness and death.

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