How often should I get a COVID booster?

Editor’s Note (April 18, 2023): April 18, Food and Drug Administration Second bivalent COVID booster approved People aged 65 and over who received their first bivalent vaccine at least 4 months ago and immunocompromised people who received their first bivalent vaccine at least 2 months ago. Additional doses may be given to immunocompromised people at the discretion of the healthcare provider.

Many people in the United States who are fully vaccinated and have received a COVID boost will be six months away from their last boost in the fall of 2022, so to receive another layer of protection , in some cases eagerly waiting. But most people should continue. wait.Late last month, the Centers for Disease Control and Prevention Supports existing COVID vaccination recommendations: The agency says only one dose of the latest updated booster, often called a bivalent booster, is needed so far. The Food and Drug Administration has only approved the same. one dose booster.

This contrasts with official guidance in other countries. early March Canada and the EnglandFor example, we have begun offering additional booster doses to certain populations at high risk of severe COVID, such as the elderly, residents of long-term care facilities, and those with compromised immune systems. World Health Organization (WHO) Countries are encouraged to consider an additional booster 6 or 12 months after the last booster dose. For the elderly, those with comorbidities, those with compromised immune systems, those who are pregnant, and frontline healthcare workers. The WHO also says healthy children from 6 months to her 17 years may not need additional boosters.

William Schaffner, professor of preventive medicine and health policy at Vanderbilt University Medical Center and consultant to the CDC’s Advisory Committee on Immunization Practices (ACIP), said: “One of the most difficult things I have learned from this pandemic is how difficult it is for the general public to respond to recommendations that change over time. increase.”

This uncertainty poses challenges for both the general public and healthcare stakeholders, including ACIP members. What do these recommendations mean for people who are particularly at risk of developing severe her COVID and need additional protection? Scientific American We spoke to the experts to find out what is known and not known about the level of immunity conferred by COVID boosters, what it means to get additional boosters that are not recommended, and what will happen by this fall. We investigated the possibility of such a situation.

How will current bivalent vaccination rates affect the new guidance?

of divalent booster Available in the US in September 2022. It was formulated to cover his Omicron strains BA.4 and BA.5 of the virus that causes COVID, as well as the original strain of 2020. The first wave of people received boosters in the fall, and in early winter, vaccination coverage declined.

Fully Vaccinated and Boosted Numerous people I want to another Boosters for extra protection, says Schaffner, but far more people still haven’t received any boosters at all.that’s all 16.7% of the US population (about 55 million) were the latest cases, far fewer than officials had hoped. increase. “The purpose of public health today is to get people on drugs, not to give them an extra boost. beginning Bivalent booster.

The CDC says it continues to monitor new data, but maintains its latest COVID vaccine recommendations for eligible people over the age of 6 months. “Too few people, especially those who are older and at high risk for severe COVID-19, have taken advantage of having the latest version of the novel coronavirus vaccine. We encourage you to consider it,” said CDC President Kristen Nordlund.

Scientists from the Vaccine Working Group within ACIP released the data in February. Vaccine coverage is declined After each official recommendation of an additional doseScientists pointed to several factors, including vaccine and COVID “fatigue” and the perception that the first vaccination provided sufficient immunity.

What do we know about the effectiveness and immunity levels of bivalent boosters?

Recent studies have shown that bivalent boosters effectively prevent severe illness and death. In his February, the CDC reported that the mortality rate for those receiving bivalent boosters was 14 times lower than unvaccinated people and one-third of those who received the first round of COVID vaccines but did not receive a booster.Other early estimates also point to a bivalent booster Enhanced protection against Omicron’s two newest strains, XBB and XBB.1.5.in persons who have received at least two previous doses of monovalent vaccine, for at least the first 3 months after vaccination.

In particular, bivalent injections are particularly effective against COVID-related hospitalizations in the elderly. But U.S. residents over the age of 65 get this booster at a lower than expected rate, with just 42% of that population getting it. Carlos Del Rio, clinician and epidemiologist at Emory University. “If you say she’s 40 and doesn’t have an underlying medical condition, you don’t need to urgently get another booster,” Dell says Rio. “But if you’re over 65, that’s a problem.”

Little is known about the duration of immunity after bivalent vaccination. However, ACIP’s COVID Vaccine Working Group said its information on the original his monovalent series and boosters suggests that protection against hospitalization begins to wane four months after a person receives the dose. says there is. “It’s not going to be zero,” says Schaffner. “In a few months, it could go from 90% to 70% he. So in terms of the population base, we’re still well protected.”

However, on an individual basis, the loss of protection becomes more complicated, especially in high-risk groups. According to research, Efficacy of monovalent COVID vaccine In certain immunocompromised people, especially organ or stem cell transplant recipients, it is lower than in others. [high-risk groups] If it’s been five to six months since I received my first bivalent booster, how do I get my spring or summer booster? That’s a perfectly reasonable question,” says Schaffner.

Protection seems to be restored After people received additional doses over time, according to ACIP. ACIP meeting in February. But she added. [people] Those who have not taken advantage of the opportunity to obtain a bivalent vaccine. “

If I need a booster, can I get another booster?

Some members of the ACIP meeting in February urged FDA and CDC to provide flexibility on vaccine guidance and availability as new data become available, especially for high-risk populations. I asked you to His ACIP member Michael Hogue, a professor of pharmacy at Loma Linda University, suggested that people discuss this with clinicians at the meeting. “We want these clinicians to be able to make appropriate decisions based on the comfort and wishes of each individual patient, as long as we keep safety in mind. “It’s pretty clear that there really are vaccines that are very safe with vaccines,” Hoag said. “

With the latest recommendations, that flexibility technically does not exist. Some have been able to “manipulate the system” to get additional boosters, Schaffner said, adding that “there is no vaccine police.”

You may have to do a little shopping to find a “friendly pharmacist” willing to provide that extra dose. Many pharmacies and clinics do not. [provide one] Because they don’t have the authority to do it,” he says. “It would operate outside of the emergency use authorization for which the vaccine is currently available.”

Those who obtain additional boosters do so at their own risk and treatment for side effects is not covered by insurance. government program We are empowered to provide benefits during the COVID public health emergency. “If you get vaccinated outside of current guidelines, you are kind of out there on your own. ‘, says Schaffner. The ACIP working group found that the longer the interval between his two doses in the primary series, the lower the risk. myocarditis—Inflammation of heart tissue that occurred in a small number of people who received the COVID vaccine.However, the risk of health problems Very low on any of the COVID vaccines.

Amira Roess, professor of global health and epidemiology at George Mason University, questions how single-dose booster guidance might affect access to vaccines for some people.

“What does that mean in terms of health equity? It means we need regular health care providers, and there are many people in this country who do not have access to quality care. I know,” says Roess. “If you can’t get boosters, [a local pharmacy]If you have a compromised immune system and don’t see your healthcare provider regularly, you may not have access to extra boosters, even if you know you need them. “

Barriers to access persist among those experiencing homelessness, people with disabilities, and some minority groups. As of April 5, according to CDC data, 9.2% of those who identify as Black and 8.8% of those who identify as Hispanic or Latinx Received the latest booster.

“If a second booster were also mandated, you could imagine this equity gap being even greater,” says Jacinda Abdul Mutakabir, a clinical pharmacist and assistant professor at the University of California, San Diego. She adds that the federal government’s official end of the COVID public health emergency set for May 11 will likely make equitable access even more difficult.

What does the future of COVID vaccination look like?

So far, all COVID vaccines and boosters in the US are government-backed and given free of charge. But with subsidized treatments, tests and other services, this could change soon.

“This gets complicated with the end of the public health emergency, because it means vaccines cost money,” Del Rio says. But I think that’s going to be a problem going forward.I don’t know what the insurance plan will do.”

Schaffner and colleagues say they’ve heard that the FDA is considering emergency-use authorization for spring or summer boosters in high-risk groups. Several news report It also hints that such an announcement could be made in the coming weeks. When asked for comment, the FDA said it continues to monitor new data and that such decisions are based on new information.

“By simplifying COVID-19 vaccine regimens in the not-too-distant future, we hope that over the next few years more individuals will be vaccinated, learn to live with SARS-CoV-2, and avoid hospitalizations and deaths. We hope that this will potentially reduce serious consequences such as,” an FDA spokesperson wrote in an email. Scientific American.

Schaffner said current CDC and FDA guidance could suggest a step forward from rolling out COVID boosters every six months to an annual vaccination schedule. Many experts anticipate that the next booster will come around the time flu shots are available in the fall, and that prescriptions are likely to be renewed.

“What’s very remarkable is that there are still about 250 to 300 COVID deaths in the US every day,” says Schaffner. “So it’s never a trifle.”