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 upheld her existing COVID vaccination recommendations. The agency says only her one dose of the latest updated booster (often called her bivalent booster) is needed for now. The Food and Drug Administration also only approves the same his single-dose booster.
This contrasts with official guidance in other countries. For example, Canada and the UK began offering additional booster doses in early March to specific populations at high risk for severe her COVID, including the elderly, residents of long-term care facilities, and those with compromised immune systems. I was. The World Health Organization (WHO) recommends 6 or 12 months after the last booster dose for the elderly, those with comorbidities, those who are immunocompromised, pregnant, and frontline health workers. Countries are encouraged to consider additional boosters at a later time. 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?
The currently available bivalent booster in the US was launched in September 2022. This was prescribed to cover his Omicron strains BA.4 and BA.5 of the virus that causes COVID, as well as the original 2020 strain. During autumn and early winter, vaccination coverage declined.
Many fully vaccinated and boosted I want to another Boosters for extra protection, says Schaffner, but far more people still haven’t received any boosters at all. Only 16.7% of the U.S. population (about 55 million people) have been infected with the latest virus, much less than officials had hoped. “This has clearly been a source of considerable disappointment for everyone involved in public health,” says Schaffner. “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. declined After each official recommendation of an additional dose. Scientists 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. The CDC said in February that the death rate for people who received a bivalent booster was 14 times lower than for those who had never been vaccinated, the first of his series of COVID vaccines. reported that he was one-third of those who did not receive a booster. Another early estimate is that bivalent boosters are those who have received at least two previous doses of the monovalent vaccine and who are immune to XBB, the two most recent Omicron strains, for at least the first three months after vaccination. and XBB.1.5.
In particular, bivalent injections are particularly effective against COVID-related hospitalizations in the elderly. However, U.S. residents over the age of 65 are taking this booster at a lower than expected rate, with only 42% of that population taking it. “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. Studies have demonstrated that monovalent COVID vaccines are less effective in certain immunocompromised people, especially organ or stem cell transplant recipients, than in others. “Isn’t that appropriate? [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 appears to return as people receive 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 treatments for side effects are not covered by government programs 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. An ACIP working group found that the longer the time between the two doses of the primary series, the lower the risk of myocarditis. This is inflammation of the heart tissue that has occurred in a small number of people who have received the COVID vaccine. However, the risk of health problems from the COVID vaccine is very low.
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. We already 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, only 9.2% of people who identify as Black and 8.8% of people who identify as Hispanic or Latino have received the latest booster, according to CDC data.
“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. When asked for comment, the FDA said it continues to monitor emerging 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 in the fall, coinciding with flu shots, and that prescriptions will likely 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.”
