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    The new COVID boosters: What doctors and patients need to know

    The shots offer more protection as new variants emerge. Experts explain why people should get them, how they differ from earlier vaccines, and factors patients should consider.

    Digital generated image of syringe filling of COVID-19 vaccine from bottle against viruses on blue background.

    New COVID-19 vaccines are now available to a public that is sick of COVID-19. Doctors want people to get them anyway.

    The arrival of another round of COVID-19 vaccines this week offers more protection for a population that is weary of the disease and has built up some immunity, but that remains vulnerable to new variants that are taking hold.

    The Food and Drug Administration (FDA) approved the boosters by Moderna and Pfizer-BioNTech on Monday, and the Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices followed up on Tuesday with a recommendation that they be given to anyone six months of age or older. The vaccines are designed to protect against the latest variants of the SARS-CoV-2 virus, which causes the disease.

    The recommendation comes as COVID-19 cases, hospitalizations, and deaths are increasing, but remain far below the levels that the country experienced through most of the pandemic.

    “We don’t want to live like we’re in a pandemic, but we want to be aware of what’s going on,” said committee member Wilbur Chen, MD, MS, professor of medicine at the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine. “Our hospitals are not overwhelmed, but people are dying daily.”

    Below, academic researchers answer key questions that doctors and patients have about the vaccines.

    Oh, please: Another COVID-19 shot?

    People are emotionally done with COVID-19 and are confused by never-ending reports about new variants with unpronounceable names. But experts say several continuing developments are behind the push for another round of inoculation against COVID-19.

    First, COVID-19 remains one of the most powerful respiratory illnesses in the country. Although the United States declared the pandemic over last May, the numbers of severe cases have been slowly growing in recent months.

    “Hospitalization rates have increased in all age groups since mid-July,” and those rates are “far higher” than the rates for influenza, Fiona Havers, MD, MHS, commander of the Coronavirus and Other Respiratory Viruses Division of the U.S. Public Health Service, told the advisory committee on Tuesday.

    Hospitalization rates for COVID-19 rose from 1.95 per 100,000 people in the week ending July 8 to 5.68 in the week ending Sept. 2, according to the CDC. During most weeks since mid-July, 500 to 600 people have died from COVID-19, the agency reports. Still, those figures remain low compared with the peaks of the pandemic, when 2,000 to 3,000 people were dying from the disease each week.

    “The majority of the U.S. population has some immunity” due to previous inoculations or infection, CDC epidemiologist Megan Wallace, DrPH, told the committee. But “new variants have emerged” and “hospital admissions are likely to increase this winter.”

    Second, the new variants might circumvent immunity that had been gained through previous inoculations and infections.

    “The virus is changing over time, forcing us to stay on our toes in terms of whether we’re adequately protected from new variants,” Amanda Simanek, PhD, MPH, associate professor in the Department of Foundational Sciences and Humanities in the Chicago Medical School at Rosalind Franklin University of Medicine and Science, said in an interview. “If the next time our body encounters that virus, if it looks different than the other time, we’re not as well equipped to respond to it.”

    Third, she and Chen noted that the immune response from previous inoculations and infections wanes over time. “If you want to get maximum protection for yourself or the people around you, then you would lose [some of] that protection” without another vaccination, Chen said in an interview.

    How do the new vaccines differ from the previous ones?

    The new vaccines are designed specifically to protect against one of the newer strains of the virus: the XBB.1.5 version of Omicron, which was the dominant subvariant in June, when the FDA selected a strain to target this fall. The process is somewhat similar to how the makeup of flu vaccines change every year according to the prevalence of certain strains (although SARS-CoV-2 has not fallen into a season pattern like the flu).

    “You can’t get a flu vaccine once in your life” and be protected from the flu forever, Simanek noted, because of changes to the virus and which strains circulate at different times.

    The two newly approved vaccines are the first COVID-19 vaccines in the United States that do not target the original virus.

    “The original virus basically doesn’t circulate anymore,” said Simanek, who writes about the virus and other matters for Those Nerdy Girls, a group of researchers and clinicians who aim to provide trusted health information.

    Both newly approved vaccines were developed with messenger RNA (mRNA) technology. The FDA and the CDC are considering another vaccine, made by Novavax, that is not developed with mRNA. That vaccine contains the spike protein of the original virus and also targets strains related to XBB.

    “There’s a lot of interest in having non-mRNA vaccines available,” Demetre Daskalakis, MD, director of the Division of HIV/AIDS Prevention in the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, told the committee.

    If other strains become predominant, can these vaccines protect against those?

    Various subvariants have been emerging, including those designated BA.2.86 and EG.5, and might become dominant in the United States, CDC researchers told the committee. Natalie Thornburg, PhD, lead research microbiologist at the CDC, noted that those subvariants are basically on the XBB family tree.

    “There’s a lot of viral diversity” among variants of SARS-CoV-2, but “almost all circulating [subvariants] are in the XBB lineage,” Thornburg said.

    That means vaccines designed to protect against XBB are likely to protect against variants that are related to it. Moderna, Pfizer, and Novavax told the CDC that their tests show that the new vaccines generate strong antibody response to, and therefore at least some protection against, emerging strains.

    “There have been a number of study results that are giving us confidence that this monovalent updated vaccine is going to effectively neutralize the emerging variants that are now coming online,” Simanek said.

    What does “protection” mean?

    Ideally, the vaccines will prevent someone from getting infected, but study data indicate that their primary benefit is protecting infected people from severe illness.

    “What we should expect from these vaccines is that they protect you against hospitalization and severe complications, and even death,” Chen said.

    When will the vaccines be available and at what cost?

    Moderna and Pfizer told the committee they will get supplies to some hospitals, doctors’ offices, and pharmacies within a day or two of Tuesday’s CDC recommendation.

    It is expected that most health insurance policies will cover the cost of the vaccines, Georgina Peacock, MD, director of the Immunization Services Division at the CDC, told the committee. Medicare does cover them without a cost to beneficiaries. The CDC oversees a Bridge Access Program to provide free vaccinations to those who don’t have insurance to cover it.

    “The goal is no-cost, timely access for all,” Peacock told the committee.

    Who does the CDC say should get the shots? Are certain populations deemed to be priority?

    Everyone age six months and up is eligible.

    “Just like with influenza, we should vaccinate everyone,” Chen said. “The people who will get the highest benefit are probably going to be older adults and the immune-compromised. I think we have plenty of vaccine, so we felt confident about making a universal recommendation.”

    When should people get these vaccines? Should they combine them with vaccines for the flu and RSV?

    The answer depends on the patient’s circumstances; they should consult their doctors if they are unsure. The factors include a person’s vulnerability to each disease, past side-effect responses to the COVID-19 and flu vaccines, and efficiency.

    COVID-19 and respiratory syncytial virus (RSV) are circulating now, so it makes sense for vulnerable populations to get at least one or both of those inoculations as soon as possible. (RSV is recommended for anyone 60 and over.) Simanek said people might choose to wait until October for the flu shot, so as to extend their protection through the typical flu season peak of December through February.

    All things being equal, Chen prefers that people get all vaccinations for which they are eligible at the same time, rather than trying to complete multiple inoculation appointments.

    “We’re trying to make sure these visits are efficient from the point of view of the patient and do not result in a missed opportunity,” he said.

    People who have fall and winter plans for traveling and for gathering with friends and family for holidays should get the vaccines in time to protect themselves and others from infection, Chen noted. He pointed out that immunity typically grows over one or two weeks after inoculation, so people should take that timing into account.

    If someone recently had COVID-19 or recently got the previous booster, when should they get this vaccine?

    People should wait about two months from their most recent dose and about three months after infection in order to maximize their protection, experts told the CDC.

    Here’s why, Simanek said: “Your body will benefit from immune protection against the virus for a while” after inoculation or infection. “You might as well ride out that period of immune protection and prolong” protection by getting the vaccine a few months later.

    Does it matter if a patient did or did not get the previous vaccines and boosters?

    Maybe, depending on factors such as which shots someone got and their age. For example, people who have had no inoculations against COVID-19 might need two rounds of one of the new inoculations, according to manufacturer presentations to the CDC. Patients should ask their doctors or pharmacists for specific guidance.

    Bottom line: What can doctors tell patients about getting the new vaccines?

    Chen said he will recommend that patients get the new vaccines “but I’m not going to be iron-fisted about it.”

    His advice to patients: “You could potentially protect more of the people around you from getting the infection and maybe getting hospitalized.”

    Simanek concurs: “The more people who uptake the vaccine, the less transmission we’re likely to have and the more protection we have as a community.”