For people who have already gotten two booster shots, should they get this third updated booster?
For those at high risk of severe disease — over 65 with comorbidities like diabetes, hypertension, heart disease, chronic lung disease, and so forth — as well as those who are immunocompromised and are most vulnerable to severe COVID, this booster is going to be highly recommended. We want to go into the fall and early winter as prepared and as protected as possible for what may come. Given that those populations are most vulnerable, they should take this recommendation seriously.
What about those individuals who have not been vaccinated yet?
The FDA was very clear that the bivalent vaccines are not meant for primary vaccination. Because the overall concentration of the mRNA material is lower, this formulation is meant to be only a booster. For the general population, it’s still recommended to get two doses of the primary series. For the immunocompromised population, the primary vaccine series is three doses. Then they can get the updated booster two months later.
How do we know that the new booster is safe and effective?
The United Kingdom had approved a bivalent vaccine that included the BA.1 subvariant, and we know from those human trials that it was quite safe with a similar set of side effects as the original vaccine, such as pain at the injection site, fatigue, and headache. Human trials are now underway for this new booster protecting against BA.4 and BA.5, but animal studies showed that it raised antibodies and mounted a good immune response. There is no expectation that this new product is going to be any less safe than the original vaccine.
Will COVID-19 boosters be reconfigured annually, like the flu shot?
Nobody really knows, but we do know that COVID-19 is not going away anytime soon. And many experts are thinking that it’s probably going to become something like influenza, that there will be seasons and variations, so we will have to be inoculated against whatever we think is coming our way. But with this mRNA platform, it’s pretty straightforward. They predict strains for influenza for the annual flu vaccine, and the same thing might potentially happen with COVID-19.
Marcus R. Pereira, M.D., MPH, is medical director of the Transplant Infectious Diseases Program at NewYork-Presbyterian/Columbia University Irving Medical Center and an assistant professor of medicine in the Division of Infectious Diseases at Columbia University Vagelos College of Physicians and Surgeons. Dr. Pereira is focused on infectious complications in patients with solid organ and bone marrow transplants as well as hematological malignancies, and provides care in both inpatient and outpatient settings. As medical director of the Transplant Infectious Diseases Program, Dr. Pereira oversees the development of infection prophylaxis and treatment protocols for immunocompromised patients. His areas of interest include multi-drug-resistant infections, including bacterial and fungal organisms in transplant patients as well as resistant cytomegalovirus infections. He is an associate editor of the American Journal of Transplantation and has led several studies this past year on the impact of COVID-19 in solid organ transplant recipients.