Five things to know about COVID, flu and RSV vaccines this fall

By Eleanor Reyes

Vaccination updates and changing recommendations alter seasonal vaccination routines

New and updated vaccines, revised recommendations for who should get certain vaccines, and access challenges are all part of the changing vaccination landscape as the U.S. enters the respiratory virus season this fall.

The Centers for Disease Control and Prevention (CDC) currently projects that the peak number of hospitalizations from COVID-19, influenza and RSV this winter will be similar to or slightly lower than last year, but that could change quickly if vaccination rates are lower than expected or if COVID-19 changes in a way that causes more severe disease, CDC Director Mandy Cohen said at a press conference Friday.

“The best plan for this winter is for everyone to remain vigilant and use the tools we have – vaccines, testing and treatments – against the diseases that are causing the majority of deaths and hospitalizations this fall and winter,” Cohen said.

The push for vaccinations this fall comes as public health officials worry that a simultaneous outbreak of COVID-19, influenza and respiratory syncytial virus could overwhelm the health care system, especially when large swaths of the population haven't been vaccinated recently. “We could end up in a situation where our hospitals don't have the capacity to take in patients. That's the scary scenario we want to avoid,” Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials, said at a press conference Wednesday.

Health officials urging people to get vaccinated are bracing for some resistance, amid signs that political divisions are fueling growing vaccine skepticism. A Gallup poll conducted in July found that only 4 in 10 Americans say it's very important for parents to vaccinate their children. That's down from 58% in 2019 and 64% in 2001, according to Gallup, and most of the decline is among Republicans and Republican-leaning independents.

And just 22.5% of U.S. adults had received last year's updated COVID vaccine as of May, according to CDC data, putting many at increased risk for more severe illness.

Here's what you need to know now to protect yourself from respiratory viruses this winter.

1. The latest COVID vaccines are expected to be available soon, but some people may want to wait a few months.

The U.S. Food and Drug Administration on Thursday approved improved versions of COVID-19 vaccines from Moderna Inc. (MRNA) and Pfizer Inc. (PFE) and its partner BioNTech, Inc. (BNTX). The timing marks an important start to preparations for the fall respiratory virus season. Nationwide, levels of COVID-19 virus activity in wastewater have been increasing throughout the summer and are now at “very high” levels, according to the CDC. CDC data shows higher rates of COVID-19 positive tests, emergency department visits, and hospitalizations, especially among older adults and children under 2 years of age.

For many people, September or October may be a good time to get their latest vaccinations, but “the key is getting the shots completed,” Cohen said Friday.

But some health officials say there's no need to rush to get the latest version of the vaccine if you've just been infected with COVID-19. Connecticut Department of Public Health Director Manisha Juthani said at a briefing for state health officials on Wednesday that people who experienced COVID-19's summer surge and are hesitant to get vaccinated right away could consider waiting a few months after their infection and getting vaccinated before the holidays.

Illinois Department of Public Health Director Samir Vohra said at a press conference that people over 65 and those who are immunocompromised remain at higher risk for more severe infection and should talk to their doctors about the best time to get vaccinated in the fall.

2. Most people can still get the COVID vaccine for free, and free testing is also being reinstated.

People with health insurance typically have no out-of-pocket costs for the COVID vaccine, but for those who are uninsured, it may be harder to get a free shot this fall.

The federal Vaccines for Children program continues to provide vaccines free of charge to uninsured children, but the CDC's Bridge Access program, which began last year and provided COVID-19 vaccines free to uninsured adults, has ended. The CDC has allocated an additional $62 million to state and local immunization programs to purchase this season's COVID vaccine and improve access for uninsured adults, Cohen said Friday. Uninsured people can contact their local and state health departments or federally qualified health centers for assistance in getting vaccinated, public health officials said. People can find a health center near them at findahealthcenter.hrsa.gov.

Dawn O'Connell, assistant secretary for preparedness and response at the U.S. Department of Health and Human Services, said at a press conference on Friday that the federal government will resume its free COVID testing program in late September. Families can order up to four free tests on COVIDTests.gov, O'Connell said.

3. Vaccination can significantly reduce the chance of long-term COVID-19.

Peter Marks, director of the FDA's Center for Biologics Evaluation and Research, told reporters on Friday that people sometimes overlook the fact that “the only way to get long COVID-19 is to get COVID-19.” He added that a growing number of studies are demonstrating that vaccination can reduce the risk of developing long-term symptoms. For example, one major study published earlier this year found that vaccination reduced the risk of long COVID-19 by 30 to 50 percent.

“I have a lot of empathy because I've seen people in their 30s and 40s who suffer from long COVID, who would otherwise be considered low risk,” Marks said. If a vaccine can reduce that risk by 50%, “I would at least personally take advantage of the benefits of getting vaccinated,” he said.

4. Recommendations for the RSV vaccine have changed since last year.

Vaccinations first became available last year to protect people at risk for severe RSV infection, such as infants and older adults. But the CDC updated its RSV vaccination recommendations for older adults in June, saying everyone 75 years of age or older should get the vaccine. This replaces a previous recommendation that people 60 years of age or older should get the shot if a patient-doctor discussion supports the decision. Under the updated recommendations, people 60 to 74 years of age who have certain chronic conditions, such as heart or lung disease, or who live in a nursing home should still get the RSV vaccine, the CDC said.

Unlike the flu shot, RSV is not an annual vaccination, so if you got an RSV shot last year, you don't need to get one this year.

GSK PLC (GSK), Pfizer and Moderna all make FDA-approved RSV vaccines for older adults. So which one should you get? “Whatever's available” is a good vaccine to get, Jutani said.

5. Even young people may need to get the RSV vaccine.

RSV can also cause severe illness in infants, and the CDC recommends vaccinating the mother against RSV or vaccinating the infant with a monoclonal antibody. The only RSV vaccine recommended for pregnant women is Pfizer's Abrizvo, which should be given between the 32nd and 36th weeks of pregnancy, between September and January, the CDC says.

Alternatively, infants under 8 months of age who are going through their first RSV season can be given a single dose of Sanofi (SNY) and AstraZeneca (AZN)'s Bayfortas, a monoclonal antibody approved by the FDA last year to prevent RSV infection in newborns and infants.

-Eleanor Reyes

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08-23-24 1438ET

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