As we head into the third winter of the pandemic, only about 13 percent of American adults — less than 11 percent of Americans overall — have received the dual-purpose COVID-19 booster.
Just about 34 million adults in the United States have opted for the new vaccine, which became available in September. The bivalent boosters, developed by Moderna and BioNTech/Pfizer, are designed to better protect people from currently circulating forms of the virus.
Medical experts say the low interest in the new recalls is due to several factors: pandemic fatigue, mixed messages from public health officials, confusion about how the new recalls are different from previous injections, and the government’s decision to authorize recalls updated without first obtaining clinical data in humans.
“It’s hard for people to get through this,” said Robert Wachter, chair of the medical department at the University of California, San Francisco. “Some of them are just throwing their hands up and saying, ‘I got shot, and that’s all I have to do.’ Which, unfortunately, it is not.
A lot has changed since 2020. We now have vaccines that do a good job of preventing most people from getting so sick that they end up in hospital or die. You can now pick up home tests from pharmacies, and there are antiviral drugs that help treat COVID and can help prevent long-term COVID, where symptoms can persist long after an infection. And now we also have upgraded boosters, which are another way to ward off the worst of the virus.
Those boosters, however, don’t confer total protection from getting sick, leading some people, especially young and healthy ones, to wonder: why get one, then?
With new variants like BQ.1 and BQ.1.1 now the dominant strains circulating in the US, and with the upcoming holidays bringing more people together to spend time socializing indoors with friends and family, it’s important to understand that your immunity, both from an infection or vaccination, decreases within four to six months. In fact, immunity to all coronaviruses declines over time “for reasons we don’t fully understand,” Kami Kim, director of infectious disease research at Tampa General Hospital’s Global Emerging Diseases Institute, told me.
“If you spent three months [after vaccination or infection]you don’t want to rely on having a BA.5 infection, because BQ.1.1 can still hit you,” said Eric Topol, president of innovative medicine at Scripps Research in La Jolla, California.
Here are answers to some common questions about COVID.
1. What is the difference between this booster and the doses available last year?
The first booster shots were simply additional, smaller doses of the original vaccine. But there are now two bivalent COVID-19 boosters available in the US: Moderna’s MRNA,
MRNA-1273.222 and the bivalent BNT162b2 from BioNTech BNTX,
and Pfizer PFE,
Both shots are designed to protect against the original strain of the virus in addition to the BA.4 and BA.5 omicron subvariants. The bivalent boosters were designed to better protect people from currently circulating forms of the virus, as well as future variants. It’s a similar approach to how flu strains are selected for the flu vaccine each year.
“It’s exactly the same technology as mRNA [as the original vaccine]but each dose now has half of the [original] variant,” said Jennifer Beam Dowd, an epidemiologist and professor of demography and population health at the University of Oxford in the U.K.
In June of this year, the US Food and Drug Administration asked drugmakers to design the next generation of COVID boosters using this formula. (In Europe, regulators took a slightly different approach, first opting for bivalent boosters that protect equally against the original virus and the BA.1 subvariant of omicron before adding a recommendation for the same bivalent formula used in the US.)
“Part of the rationale for keeping the old version and BA.4/BA.5 is that if you put all your eggs in the basket, up to BA.4/BA.5, then the virus will change to turn into more like the original version” said Kim of Tampa General Hospital. “He’s hedging your bets.”
Up until last week, BA.5 had been the dominant variant in the US, but as of Friday, BQ.1 and BQ.1.1, which are subtypes of BA.5, now make up the majority of new infections in the US, according to to the Centers for Disease Control and Prevention.
It’s not all bad news. The BQ.1.1 is closely related to the BA.5, according to Dowd, and that means many of the dual booster’s protective qualities will also protect against the new variants.
2. What does science say about the new boosters?
There is preliminary data on both bivalent boosters which seem to indicate that they work against the BQ.1.1 and BA.5. However, scientists and doctors say they’re still waiting to see peer-reviewed research from clinical trials to fully evaluate the effectiveness of both shots.
- Moderna’s booster: Early clinical data show that the bivalent booster of Moderna produced a 5- to 6-fold increase in neutralizing antibodies against the BA.4 and BA.5 variants in approximately 500 adults who had been previously vaccinated and boosted, according to a press release from the. November 14th. The Phase 2/3 clinical trial compared the response of the new booster to the company’s original booster. Moderna also said the bivalent shot increased antibodies that protect against BQ.1.1, though not as much as against BA.4 and BA.5, based on an analysis of about 40 participants in the same study.
“It’s not orders of magnitude greater protection, but at least 5 to 6 times greater protection against BA.5, that’s fine,” Topol said.
- The BioNTech and Pfizer booster: In a preprint published Nov. 17, the two companies said their bivalent booster led to an 8.7-fold increase in neutralizing antibodies against BQ.1.1 after 30 days, compared with the 1.8-fold increase in antibodies of the original booster against the same subvariant. The study evaluated immune responses in adults 55 years of age and older who had been previously vaccinated and boosted, regardless of infection history.
3. What if I have COVID this year? Does it matter when I get the booster?
Most of the experts interviewed for this story say immunity can last anywhere from three to six months, although the CDC’s official recommendation is that bivalent boosters should be given three months after a COVID infection or two months after a COVID-19 infection. last injection of an individual.
“We used to say, go ahead and get vaccinated as soon as you recover,” Dowd said. “But there has been subsequent evidence suggesting it is best to wait probably at least three months. Not because it’s bad to get it first, but you really won’t get much benefit from that boost. Reach a ceiling.
There are other considerations as well. The timing of your last infection matters if you have any idea what variants were circulating when you got sick. If you had an omicron infection last winter, you should probably get a booster. If you’ve gotten sick in the last month or so, presumably with BA.5 or one of its subvariants, you may want to wait a month or two.
“However good the vaccine is and however good the post-infection protection is, immunity and protection wane over time,” Dr. Anthony Fauci, chief medical adviser to President Joe Biden, told reporters during a briefing at the White House on Tuesday.
You also need to assess your underlying immune status, whether you have any medical conditions that put you at higher risk for serious illness, and how worried you are about long-term COVID.
“Most of the deaths we’ll see from COVID could have been prevented if people had stayed up-to-date with their recalls,” said Wachter of the University of California. “And many cases of long COVID could [also] they were prevented if people stayed up to date with their boosters.
Finally, if you plan to spend Christmas with family or travel in late December, remember that it takes a few weeks for antibodies to build up from new injections.
4. Do I really need a booster if I’m young and healthy?
We are long past the one-size-fits-all phase of the pandemic, and not all medical experts think young, healthy people need a booster right now.
Dowd said people who are “younger and healthier” can wait up to six months after a previous infection to get another shot.
“If we follow the CDC or the UK data, people who appear to benefit from the boost fall into three categories: immunocompromised people, older people – mostly over 75 – and people who have high-risk medical conditions,” he said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.
It’s unclear whether that thought influenced people’s decisions about whether to get a booster. But bivalent injections have been available for months to children older than 5 and to all adults in the United States, and that availability hasn’t garnered much interest.
“It’s for the same reason 19,500 people flock to the Wells Fargo Center [in Philadelphia] to watch the Sixers play, screaming at the top of their lungs, maskless,” Offit said. “They don’t feel obligated to get a booster dose.”
This may be due in part to the fact that hospitalizations and deaths from COVID have remained broadly stable. There is no longer the kind of urgency that used to make people book original vaccine appointments or wear masks. With the annual peak in COVID cases occurring during the first two weeks of January in 2021 and 2022, the question now is, will that level of comfort change as winter and the holiday season progress?
“People want [a booster] be like flipping a switch, like I’m 100% protected or not,” Dowd said, “but we’ve known from the first two years that when the vaccine is well matched to the variants, that the BA.5 is a decent match right now , it really reduces transmission substantially and your chances of getting infected altogether. We should take advantage of that.”