Currently the agencies have okayed the new booster from Pfizer-BioNTech for people ages 5 and up, and the new booster from Moderna for individuals 6 and up. “The updated COVID-19 boosters are formulated to better protect against the most recently circulating COVID-19 variant,” said Rochelle Walensky, MD, MPH, the director of the Centers for Disease Control and Prevention (CDC), in a statement. “They can help restore protection that has waned since previous vaccination and were designed to provide broader protection against newer variants. This recommendation followed a comprehensive scientific evaluation and robust scientific discussion. If you are eligible, there is no bad time to get your COVID-19 booster and I strongly encourage you to receive it.” Concerns about a potential COVID-19 surge this winter have made recommendations like these even more urgent. But many Americans appear to be holding off, wondering whether they really need to get yet another shot, or how long they need to wait if they recently got boosted or recovered from COVID-19. For answers to common questions about the new boosters, we turned to William Schaffner, MD, an infectious-disease specialist and a professor of preventive medicine and health policy at the Vanderbilt University School of Medicine in Nashville, Tennessee.
Q: What makes these new boosters different from the previous kind?
A: They are “bivalent,” meaning they contain material from the original vaccines, and then added to that is material that will protect us better against the subvariants of omicron that account for most of the cases today. These subvariants are better able to elude protections from current vaccines, which wane in effectiveness over time. Although previous shots offered significant protection against severe illness, the new boosters give recipients even better defenses.
Q: Does that mean we may need to get an updated COVID-19 booster every year?
A: Although nobody is committed to that yet, I think we would virtually all agree that we are headed in that direction, and by updating the booster now, that is our first step on the road toward doing that. You can think of these new shots very similarly to the way we update our annual influenza vaccine, which is reconstituted every year in order to try to get a better match with the circulating flu virus. Also, Pfizer and other companies are working toward the goal of a combined flu and COVID vaccine that would be given once a year and will perhaps be available next fall. One of the difficulties we’re having this season is that we’re asking people to get not just one vaccine — the bivalent booster — but also the usual flu shot.
Q: Will the new boosters protect against the latest omicron subvariants BQ.1 and BQ.1.1?
A: Laboratory studies tell us that these new vaccines provide reasonable protection against these variants. These new variants are descendants of omicron and the new boosters target omicron. These vaccines should produce antibodies that have reasonable activity against these variants.
Q: Who should get the new booster?
A: Everyone over the age of 5. You’re not just protecting yourself but others around you as well, including some people who are particularly vulnerable to the virus — older people, frail people, immune-compromised people, people with underlying illnesses.
Q: How long do people have to wait to get the booster if they’ve been vaccinated or already boosted or have recently recovered from COVID-19?
A: You have to wait at least two months after you’ve received your last vaccine [or first or second booster] dose and at least three months after recovering from a COVID-19 infection. If you’ve passed those intervals, that’s just fine, and it may even give you a better immune response.
Q: Does the new booster replace the previous boosters?
A: Yes. None of the previous boosters will now be offered.
Q: What if you haven’t gotten any COVID-19 vaccines? Will all shots be replaced by the new formula?
A: No. Only boosters will have the updated formula, and to get the boosters people must complete their primary series of the original vaccine [meaning two shots of a Pfizer or Moderna vaccine]. We’ve already imprinted our immune systems with the original vaccine, and we know that the traditional vaccine provides good protection against serious disease and hospitalization. We can still rely upon the original vaccine, and then with the new booster, we’ll in effect add a new wing to the house.
Q: Where are the shots available?
A: At all locations as with previous vaccines — pharmacies, clinics, doctor’s offices, health departments, clinics, and the like. [Vaccines.gov can help you find a location near you.]
Q: How much does the new booster cost?
A: At this time, the vaccine continues to be completely free — you just have to roll up your sleeve, you don’t have to reach for your wallet. Some people in Congress are saying, why don’t we just transition from pandemic funding to the way we normally fund medical care and preventive health services? But there’s an old saying I think we should follow: You don’t want to eliminate the funding before you’ve eliminated the disease.
Q: Why do you think Americans have been slow to get the new booster?
A: There is a lot of vaccine fatigue out there. Many want to put COVID behind them — in the rearview mirror, so to speak. Plus, people have seen cases going down and the latest infections appear to be milder than those in the past. Some people will have to be persuaded to come in, and that may be a challenge.
Q: Why are these updated boosters thought to be effective?
A: The FDA evaluated immunogenicity [the immune response generated by a vaccine] and safety data of the updated boosters based on research involving about 1,400 individuals who received either a bivalent vaccine (with a component of an omicron strain related to BA.4 and BA.5) or a monovalent shot (with only a component of the original strain of the virus). For participants who received the bivalent vaccine, the immune response to the omicron strain was better than the immune response of those who had received the monovalent vaccine. The companies also submitted data from mouse studies showing that the updated booster produced an overall better response to omicron variants compared with previous shots. Wider clinical trials in humans are expected to begin soon. [Note: Pfizer released study results in early November showing that its updated bivalent COVID-19 booster produced about four times the level of omicron-fighting antibodies compared to its original vaccine in individuals age 55 and older. Pfizer said that it is also monitoring the effectiveness of the vaccine against emerging omicron subvariants. Research published in the journal Nature in September, however, found that the updated shots provided roughly the same protection as existing vaccines.]
Q: With flu season upon us, can you get your flu shot at the same time as the updated booster?
A: Yes, you can get the two vaccines at the same time, and they’re usually then given one in each arm. It’s not too late to get vaccinated against either virus, but I wouldn’t linger. I worry that when people don’t get their flu and COVID shots at the same time, they don’t come back for that second vaccine — they get preoccupied with all the other things that are happening this time of the year. A vaccine deferred is often a vaccine never received. If you get vaccinated now, your protection should last in an effective way through February, which is when flu usually peaks in the United States, and into March and early April.
