The U.S. tried something new about six months ago. Federal health agencies authorized and recommended an updated COVID-19 booster shot that matched the coronavirus variants that were circulating at the time. Some Americans were quick to line up to get the latest shot.
But as the weeks rolled into months, just under 16% of the population eventually joined them. The low uptake forced health officials to focus their attention on the vast majority of Americans who hadn’t gotten the shots rather than the few that did.
Now the group of Americans who eagerly lined up when the booster was first offered are asking questions. Namely, when can they get their next shot?
“It’s one of the most common questions I’m asked right now, with varying degrees of urgency, particularly among the immunocompromised who are especially concerned because there is still quite a bit of COVID out there,” says Dr. Peter Hotez, the dean of the National School of Tropical Medicine at Baylor College of Medicine.
Federal health officials are eyeing a switch to an annual COVID-19 booster shot beginning in the fall, but some Americans are hoping to get their next shot sooner than that, citing concerns that the efficacy of the shots starts to wane after a few short months.
It’s a significant number of Americans who want to know. According to a recent survey from the Kaiser Family Foundation, 15% of all adults said they are waiting on the Centers for Disease Control and Prevention to issue new guidance on the next shot. If the survey were extrapolated to real life, it would mean that more than 38 million Americans are waiting on federal guidelines for another booster.
Among adults who received the updated booster shot, more than half say they are waiting on guidelines so they can be eligible for another booster. The vast majority of updated booster recipients – 86% – say getting another COVID-19 booster shot in the future is important or a top priority of theirs.
A CDC spokesperson said that the agency recommends only one updated bivalent booster shot at this time, adding that the majority of Americans haven’t yet received the shot. She said that updated data is expected to be shared during a meeting of its vaccine advisory committee next week.
“CDC will continue to monitor COVID-19 disease trends, variants, and vaccine safety and effectiveness to inform future vaccine recommendations,” the spokesperson said in a statement to U.S. News.
Hotez, who also serves as the co-director of the Texas Children’s Hospital Center for Vaccine Development, says he has raised the issue with leadership at the Department of Health and Human Services. He says that even if federal officials don’t want to issue a recommendation for people to get a second updated booster, they could at least authorize the shot so that people have the ability to choose for themselves.
A second booster shot is important, Hotez says, because there is still a “significant” level of COVID-19 transmission from the omicron subvariant XBB.1.5. Most of the U.S. is experiencing a high level of coronavirus transmission, according to CDC data.
Additionally, he says that it’s hard to predict what comes next with COVID-19.
“We always want to spike the ball and say, ‘We’re done.’ And I don’t know that we can say that just yet,” he says.
Booster shots are “probably best reserved for the people most likely to need protection against severe disease – specifically, older adults, people with multiple coexisting conditions that put them at high risk for serious illness, and those who are immunocompromised,” Dr. Paul Offit, a pediatrician who is also a member of the Food and Drug Administration’s vaccine panel, wrote last month in the New England Journal of Medicine.
Immunocompromised Americans are in a particularly tough spot after the FDA last month pulled its authorization of Evusheld, an antibody treatment that was used as a pre-exposure treatment for people at high risk for severe COVID-19.
But it might not be prudent to try to prevent infections in young, healthy Americans with booster shots, Offit said.
“In the meantime, I believe we should stop trying to prevent all symptomatic infections in healthy, young people by boosting them with vaccines containing mRNA from strains that might disappear a few months later,” he wrote.
Still, the latest data from the CDC found that the updated bivalent booster shot does provide protection against the now-dominant XBB.1.5. A study the agency published last month found that efficacy against symptomatic infection varied by age range, with people ages 18-49 seeing the highest level at 49% and people ages 50-64 seeing the lowest at 40%. Americans 65 years and older saw 43% vaccine efficacy against symptomatic infection with XBB.1.5 and XBB.
When the FDA last month proposed the shift to annual COVID-19 boosters, it noted that “two doses of an approved or authorized COVID-19 vaccine may be needed to induce the expected protective immunity for those who have a low likelihood of prior exposure (the very young) or those who may not generate a protective immune response (older and immunocompromised individuals).”
The FDA’s vaccine advisory committee met last month to discuss the potential annual booster strategy and touched on the idea of two vaccines per year for certain groups. The agency’s top vaccine official Peter Marks noted that immunocompromised people got an additional COVID-19 shot as a part of their primary series.
“Whether that translates into two vaccines per year … I think that’s something that we’d like to have a discussion of and use the best available data that we have,” Marks said. He added that there is a “real spectrum” among immunocompromised people ranging from “modest” to “tremendous.”
But the vaccine experts didn’t come to a strong conclusion on the strategy, instead saying that the committee needs more data to figure out exactly who would get one shot per year and who would get two.
Another updated booster authorized anytime soon would be the same composition as the first one, which was targeted against omicron subvariants BA.4 and BA.5 as well as the original coronavirus strain.
While the mRNA technology used for the Moderna and Pfizer vaccines is easily adaptable to new strains, vaccine manufacturers and federal health officials haven’t made updates to the shot.
“We really have not taken advantage of that performance feature of the mRNA vaccine because in theory we should have the XBB.1.5 version by now,” Hotez says.
Source: us news